Sleeping pills and older people: the risks

Published in Medicinewise Living

Date published: About this date

Health and medicines information in this article may have changed since the date published. This information does not replace advice from a health professional.

About 1 in 3 people is expected to have insomnia at some time in their life,1 but difficulty getting to sleep or staying asleep, or having sleep that is not refreshing occur more commonly as people age.2-4

Factors such as pain (eg, from arthritis), menopausal hot flushes, or needing to go to the toilet can cause some people to have difficulty falling asleep or cause them to wake up during the night.3 It's also more common for older people to nap during the day and sleep less at night.3

Are sleeping pills the answer?

Your doctor may discuss sleeping pills as a potential treatment if non-medicine treatments for insomnia haven't worked on their own.1,5 Sleeping pills are sometimes prescribed if your doctor expects your sleep problem to be short term or if the reasons for the insomnia are being treated but sleeping problems continue.1,6 

When it comes to sleeping pills, it is important that you understand the risks, how to use them safely and know when not to use them.1,6 Never take sleeping pills (or any other medicine) that have been prescribed for someone else.

It is also important to realise that complementary medicines (which include herbal remedies) can have potential adverse effects and interact with other medicines you take.

What are the risks?

  • Like all medicines (including complementary medicines and those obtained over the counter without a prescription), sleeping pills can cause side effects. For sleeping pills, potential side effects include drowsiness, light headedness, memory loss and poor concentration.5,7
  • It's quite easy to become dependent on some types of sleeping pills, making it difficult to stop taking them without having rebound sleep problems or unpleasant 'withdrawal' effects.5-7
  • You may wake up feeling groggy (a 'hangover') after using some sleeping pills or feel drowsy, lethargic, less alert or less able to focus the next day.1,5 Some sleeping pills can cause temporary memory loss in older people.5
  • Sleeping pills that make you feel groggy the next morning can increase your chance of falling or having an accident.5,8 If you feel this way, avoid driving or operating heavy machinery.5
  • Mixing sleeping pills with alcohol, illegal drugs, or other medicines (eg, some pain relievers, some cough and cold medicines) can further increase your risk of experiencing side effects.5
  • Some sleeping pills prevent you from sleeping as deeply as you need to in order to feel rested the next day, and can occasionally lead to sleepwalking and other abnormal sleep-related behaviours.1,5

The risks are greater as you age

Recent research suggests the potential risks of using sleeping pills may increase as you get older.8

Sleeping pills that belong to the group of medicines known as benzodiazepines and contain active ingredients such as temazepam, oxazepam, diazepam, can be problematic1,8 – older people are at greater risk of becoming confused, experiencing memory loss, or having a fall and/or a fracture when taking a sleeping pill of this type.1,8 You are also more likely to need to be hospitalised unexpectedly.8 These risks are even greater if you are taking other regular medicines as well as sleeping pills.8

Z-drugs are not necessarily a safer alternative

One class of sleeping pills, often referred to as z-drugs (such as zolpidem or zopiclone), are sometimes promoted as being safer than other sleeping pills. However, the 'hangover effects', memory loss and potential for side effects and serious accidents are still possible with these medicines, as are issues with tolerance, dependence, withdrawal symptoms and rebound sleep problems.1,5,7

There is no convincing evidence that these newer sleeping pills are safer or more effective for sleep than a benzodiazepine medicine.1,5

Ways to sleep better without medicines

Behavioural therapies such as progressive muscle relaxation, breathing exercises, meditation, counselling support and advice (eg, cognitive therapy) and good sleep habits are the best ways to manage sleep problems long term.1,3,7,9

These non-medicine therapies can take a few weeks to start working,1 but unlike sleeping pills (both benzodiazepines and z-drugs), they:

  • focus on correcting the factors that often contribute to sleep problems
  • let your body sleep as deeply as it needs to so you feel rested the next day
  • don't cause the side effects, dependence and other possible harms of sleeping pills.

How to develop good sleep habits1,7,9,10

Regulate your sleep

  • Try to go to sleep and wake up at the same times each day.
  • Avoid naps during the day. If you do nap, keep it to 20 minutes.
  • Avoid oversleeping.
  • Avoid bright light in the evening.
  • Seek out some bright light when you wake up each morning.
  • Don't stay in bed worrying. If you're awake for more than 20 minutes — go to another room and do something that relaxes you, such as reading a book, listening to music or meditating.

Create a sleep-friendly environment

  • Be as active as possible during the day, exercise and spend some time outdoors.
  • Don't eat, work, watch television, read or discuss problems in bed.
  • Avoid working on a computer, tablet or smartphone late in the evening.
  • Avoid caffeinated drinks after midday and reduce your overall daily caffeine intake.
  • Avoid heavy meals and vigorous exercise within 3 hours of going to bed.
  • Avoid smoking and drinking alcohol in the evening.
  • Keep your pets, the TV, and brightly lit digital clocks out of the bedroom.

Do things that promote sleep

  • Relax for 30 minutes before going to bed (eg, have a warm bath).
  • Make sure your bedroom is not too hot or cold.
  • Ensure you are comfortable and your bedroom is quiet and as dark as possible.

Talk with your health professional about which non-medicine therapies best suit your situation and where you can get further support to learn relaxation techniques or access counselling.

If you have tried these tips and are still having problems with sleep, ask your doctor about other treatment options. Your doctor will help you find what works for you and may also refer you to a sleep specialist, a sleep clinic, or suggest you fill out a sleep diary.

There are a large number of sleep clinics across Australia. To find out which clinics are in your area, contact your local branch of Sleep Disorders Australia.

Play it safe with sleeping pills

Talk with your doctor or other health professional if you're thinking about starting sleeping pills or they've been recommended to you by family or friends.

In the long term, sleeping tablets are unlikely to help your insomnia and, in some cases, may do more harm than good.7

If you're worried you may have had a side effect related to a sleeping pill or any other medicine, seek medical advice.

To report possible side effects call the Adverse Medicine Events (AME) Line on 1300 134 237 from anywhere in Australia (Monday–Friday, 9am–5pm AEST).

People with questions about their medicines or seeking general information about side effects can call NPS Medicines Line on 1300 633 424 (Monday–Friday, 9am–5pm).

Find out more

References
  1. Therapeutic Guidelines Ltd. Insomnia, parasomnias and jet lag (Revised June 2013). Psychotropic version 7, 2013 (eTG 43 November 2014) Therapeutic Guidelines Ltd 2014. [Online] (accessed 10 March 2015.
  2. NHS Choices. Insomnia. England, UK: NHS England, 2013. [Online] (accessed 10 March 2015).
  3. Sleep Health Foundation. Ageing and sleep. Sydney, Australia: Sleep Health Foundation, 2011 (Updated December 2014). [Online] (accessed 10 March 2015).
  4. Sleep Health Foundation. Insomnia. Sydney Australia: Sleep Health Foundation, 2011 (Updated March 2015). [Online] (accessed 10 March 2015).
  5. Australian Medicines Handbook. Psychotropic drugs. Australian Medicines Handbook Adelaide, SA: Australian Medicines Handbook Pty Ltd., 2014 (Updated January 2015). [Online] (accessed 10 March 2015).
  6. Sleep Health Foundation. Sleeping tablets. Sydney, NSW: Sleep Health Foundation, 2011 (Updated November 2014). [Online] (accessed 10 March 2015).
  7. NHS Choices. Insomnia - Treatment. England, UK: NHS England, 2013. [Online] (accessed 10 March 2015).
  8. SD Price, CD Holman, FM Sanfilippo, et al. Impact of specific Beers Criteria medications on associations between drug exposure and unplanned hospitalisation in elderly patients taking high-risk drugs: a case-time-control study in Western Australia. Drugs Aging 2014;31:311-25. [PubMed]
  9. Sleep Health Foundation. Good sleep habits. Sydney, NSW: Sleep Health Foundation, 2011 (Updated November 2014). [Online] (accessed 10 March 2015).
  10. Sleep Health Foundation. Understanding and helping poor sleep. Sydney, NSW: Sleep Health Foundation, 2013 (Updated November 2014). [Online] (accessed 10 March 2015).