Insomnia and Anxiety in Older People

Almost one-third of older people in the U.S. take sleeping pills. These drugs are called “sedative- hypnotics” or “tranquilizers.” They affect the brain and spinal cord.

Doctors prescribe the drugs for sleep problems. The drugs are also used to treat other conditions, such as anxiety or alcohol withdrawal.

Usually older adults should try nondrug treatments first. According to the American Geriatrics Society, there are safer and better ways to improve sleep or reduce anxiety. Here’s why:

Sleeping pills may not help much.

Many ads say that sleeping pills help people get a full, restful night’s sleep. But studies show that this is not exactly true in real life. On average, people who take one of these drugs sleep only a little longer and better than those who don’t take a drug.

Sleeping pills can have serious, or even deadly side effects.

All sedative-hypnotic drugs have special risks for older adults. Seniors are likely to be more sensitive to the drugs’ effects than younger adults.

And these drugs may stay in their bodies longer.

The drugs can cause confusion and memory problems that:

• More than double the risk of falls and hip fractures. These are common causes of hospitalization and death in older people.
• Increase the risk of car accidents.

The new “Z” drugs also have risks.

Most ads are for these new drugs. At first, they were thought to be safer. But recent studies suggest they have as much or more risk than the older sleep drugs.

Try treating without medicines first.

Get a thorough medical exam. Sleep problems can be caused by depression or anxiety, pain, restless leg syndrome, and many other conditions. Even if an exam does not turn up an underlying cause, you should try other solutions before you try drugs.

Kinds of sleeping pills

All of these pills have risks, especially for older adults:

Barbiturates

• Secobarbital (Seconal and generic)
• Phenobarbital (Luminal and generic)

Benzodiazepines
For anxiety:

• Alprazolam (Xanax and generic)
• Diazepam (Valium and generic)
• Lorazepam (Ativan and generic)

For insomnia:

• Estazolam (generic only)
• Flurazepam (Dalmane and generic)
• Quazepam (Doral)
• Temazepam (Restoril and generic)
• Triazolam (Halcion and generic)

”Z” drugs

• Zolpidem (Ambien and generic)
• Eszopiclone (Lunesta)
• Zaleplon (Sonata and generic)

Over-the-counter drugs may not be a good choice.

Side effects of some drugs can be especially bothersome for seniors: next-day drowsiness, confusion, constipation, dry mouth, and difficulty urinating. Avoid these over-the-counter sleep drugs:

• Diphenhydramine (Benadryl Allergy, Nytol, Sominex, and generic)
• Doxylamine (Unisom and generic)
• Advil PM (combination of ibuprofen and diphenhydramine)
• Tylenol PM (combination of acetaminophen and diphenhydramine)

When to try sleeping pills.

Consider these drugs if the sleep problems are affecting your quality of life and nothing else has helped. But your health-care provider should watch you carefully to make sure that the drug is helping and not causing bad side effects.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

09/2013