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The side effects (and effectiveness) of sleeping pills prescribed to older adults

sleeping pills for elderly

Image credit: FreeImages/Steve Knight

Insomnia tends to be more prevalent in older adults. As a result, older individuals are more likely to seek help for their sleep issues, which unfortunately leads to higher rates of sleeping pill use.

A 2016 review published in Clinical Therapeutics set out to determine the safety and efficacy of sleep medicines prescribed to older adults. Its findings are outlined below.

I am not a doctor. I am simply sharing peer-reviewed research. All questions regarding medication should be directed to a qualified healthcare professional.

Benzodiazepines for sleep

Estazolam

What effect does estazolam have on sleep?

Estazolam can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of estazolam?

Potential side effects and adverse effects include:

  • Daytime drowsiness
  • Dizziness
  • Lightheadedness
  • Dementia
  • Fall risk
  • Hip fractures
  • Mobility problems

Temazepam

What effect does temazepam have on sleep?

Temazepam can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of temazepam?

Potential side effects and adverse effects include:

  • Drowsiness
  • Dizziness
  • Dementia
  • Fall risk
  • Hip fractures
  • Mobility problems

Triazolam

What effect does triazolam have on sleep?

Triazolam can address sleep onset latency, helping individuals fall asleep faster.

What are the side effects of triazolam?

Potential side effects and adverse effects include:

Flurazepam

What effect does flurazepam have on sleep?

Flurazepam can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of flurazepam?

Potential side effects and adverse effects include:

  • Residual daytime sedation
  • Confusion
  • Dizziness
  • Impaired motor coordination
  • Fall risk
  • Motor vehicle accidents

Are benzodiazepines recommended for sleep problems in seniors?

The review pointed out that even if benzodiazepines are used for only a few days, they have the potential to cause physical dependence. Researchers concluded that benzodiazepine use should be avoided in the elderly, yet if they are used, the lowest dose for the shortest duration is preferred and follow-up visits should be scheduled every six months.

Nonbenzodiazepine receptor antagonists for sleep

Eszopiclone

What effect does eszopiclone have on sleep?

Eszopiclone can address sleep onset latency, helping individuals fall asleep faster. It can also address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of eszopiclone?

Potential side effects and adverse effects include:

  • Headache
  • Unpleasant taste
  • Somnolence (sleepiness/drowsiness)
  • Dyspepsia (impaired digestions)
  • Dry mouth
  • Dizziness

Zolpidem

What effect does zolpidem have on sleep?

Zolpidem can address sleep onset latency, helping individuals fall asleep faster. It can also address sleep maintenance issues, helping individuals stay asleep and it can be used for nighttime awakenings.

What are the side effects of zolpidem?

Potential side effects and adverse effects include:

  • Headache
  • Dizziness
  • Drowsiness
  • Nausea
  • Vomiting
  • Anterograde amnesia
  • Hallucinations
  • Delirium
  • Unusual nighttime behaviors

Zaleplon

What effect does zaleplon have on sleep?

Zaleplon can address sleep onset latency, helping individuals fall asleep faster.

What are the side effects of zaleplon?

Potential side effects and adverse effects include:

  • Headache
  • Nausea
  • Dizziness
  • Somnolence (sleepiness/drowsiness)
  • Rhinitis (stuffy nose)
  • Asthenia (physical weakness/loss of strength)
  • Abdominal pain

Are nonbenzodiazepine receptor antagonists recommended for sleep problems in seniors?

The review concluded that nonbenzodiazepine receptor antagonists have better safety profiles compared to benzodiazepines, but the recognized side effects should limit their use in the elderly.

Melatonin receptor agonists for sleep

Ramelteon

What effect does ramelteon have on sleep?

Ramelteon can address sleep onset latency, helping individuals fall asleep faster.

What are the side effects of ramelteon?

Potential side effects and adverse effects include:

  • Headache
  • Somnolence (sleepiness/drowsiness)
  • Nasopharyngitis (common cold)

Orexin antagonists for sleep

Suvorexant

What effect does suvorexant have on sleep?

Suvorexant can help individuals fall asleep (sleep induction) and it can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of suvorexant?

Potential side effects and adverse effects include:

  • Somnolence (sleepiness/drowsiness)
  • Fatigue
  • Headache
  • Dry mouth
  • Residual daytime sedation
  • Sleep paralysis
  • Fall risk

Antidepressants for sleep

Trazodone

What effect does trazodone have on sleep?

Trazodone can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of trazodone?

Potential side effects and adverse effects include:

  • Residual daytime sedation
  • Headache
  • Nausea
  • Vomiting
  • Xerostomia (dryness in the mouth)

Mirtazapine

What effect does mirtazapine have on sleep?

Mirtazapine can address sleep onset latency, helping individuals fall asleep faster. It can also be used for nighttime awakenings.

What are the side effects of mirtazapine?

Potential side effects and adverse effects include:

  • Residual daytime sedation
  • Anticholinergic effects
  • Weight gain

Doxepin

What effect does doxepin have on sleep?

Doxepin can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of doxepin?

Potential side effects and adverse effects include:

  • Headache
  • Somnolence (sleepiness/drowsiness)
  • Sedation
  • Mild anticholinergic effects

Are antidepressant medications recommended for sleep problems in seniors?

The review concluded that sedating low-dose antidepressants may be a good option for insomnia when the individual is also suffering from depression.

Researchers identified trazodone as the safest option due to the lack of anticholinergic activity. The review suggested that mirtazapine may be beneficial for insomnia in those suffering from frailty syndrome since the drug also stimulates the appetite.

Miscellaneous medications for sleep

Gabapentin

What effect does gabapentin have on sleep?

Gabapentin can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of gabapentin?

Potential side effects and adverse effects include:

  • Drowsiness
  • Somnolence (sleepiness/drowsiness)

Pramipexole

What effect does pramipexole have on sleep?

Pramipexole can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of pramipexole?

Potential side effects and adverse effects include:

  • Insomnia
  • Hallucinations

Tiagabine

What effect does tiagabine have on sleep?

Tiagabine can be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of tiagabine?

Potential side effects and adverse effects include:

  • Drowsiness

Are these medications recommended for sleep problems in seniors?

The review pointed out that although pramipexole and tiagabine have been used for insomnia, they have considerable adverse effects and have not been extensively studied in the older population.

Researchers pointed out that gabapentin may be useful in those suffering from restless legs syndrome or chronic neuropathic pain and insomnia.

Over-the-counter medications for sleep

Diphenhydramine

What effect does diphenhydramine have on sleep?

Diphenhydramine may be used to address sleep onset latency, helping individuals fall asleep faster. It may also be used to address sleep maintenance issues, helping individuals stay asleep.

What are the side effects of diphenhydramine?

Potential side effects and adverse effects include:

  • Residual daytime sedation
  • Anticholinergic effects

Valerian

What effect does valerian have on sleep?

Valerian may be used to address sleep onset latency, helping individuals fall asleep faster.

What are the side effects of valerian?

Potential side effects and adverse effects include:

  • Drowsiness
  • Headache
  • Depression

Melatonin

What effect does melatonin have on sleep?

Melatonin may be used to address sleep onset latency when taken within an hour of sleep, helping individuals fall asleep faster.

What are the side effects of melatonin?

Potential side effects and adverse effects include:

  • Residual daytime sedation

Are over-the-counter medications recommended for sleep problems in seniors?

The review concluded that diphenhydramine isn't suitable for the elderly due to its anticholinergic effects. Furthermore, researchers pointed out that tolerance can develop after one to two weeks of uninterrupted use.

Melatonin may be an option due to the low side effect risk, yet data remains inconsistent. Researchers pointed out that both valerian and melatonin are unregulated (in the United States).

Conclusion (and a few words about cognitive behavioral therapy)

The authors of this review confirmed that  cognitive behavioral therapy for insomnia should always be the initial therapy for insomnia. 

For pharmaceutical options, researchers singled out ramelteon as a potentially desirable option for older patients who have tried sleep hygiene without success due to low adverse effects combined with its effectiveness at reducing sleep onset time and increasing total sleep time.

Suvexorant was also mentioned due to its effectiveness at reducing sleep onset and increasing total sleep time, but researchers pointed out that although adverse effects are also mild, residual daytime sedation has been reported and there is currently limited clinical experience with the drug.

The fact of the matter is this:  sleeping pills do not cure insomnia.  They may offer relief in the short term, but if you want to address your sleep issues permanently, cognitive behavioral therapy for insomnia is usually the best option.

Source: Clinical Therapeutics

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Last updated: February 16, 2017

This Article Was Written By

Martin Reed

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