Insomnia is a serious problem for millions of Americans. Older adults often have difficulty getting to sleep, and many rely on sleeping pills. Unfortunately, benzodiazepines like alprazolam (Xanax) and z-drugs like zolpidem (Ambien), zaleplon (Sonata) and eszopiclone (Lunesta) have been linked to dementia. [For details, see the articles by Billioti de Gage et al, BMJ, Sep. 27, 2012; Zhong et al, PLOS One, May 27, 2015 and Schroeck et al, Clinical Therapeutics, Nov. 2016.] If Ambien is out of the question, how else can a person get the ZZs he or she needs?
How Does a Doctor Decide Ambien Is Out?
Q. I am a 77-year-old man who has been taking zolpidem (Ambien) for 15 years so I can get the sleep I need. Now, however, I have a new primary care physician who will not renew my prescription because “it is not within the guidelines for those 65 and older.”
I have explained to the doctor that I need this medicine to fall asleep. Moreover, in the 15 years I have taken it, I have never, ever, had a side effect. Until just three months ago I worked a job that required me to wake at 5:40 in the morning and I still had zero side effects.
My doctor is adamant, however, and has prescribed trazodone, which is apparently within the guidelines. However, I read the warnings that come with the prescription and found that those with kidney disease should not take trazodone. I have Stage 3 kidney disease. Can you suggest another sleep aid that is not hazardous to my remaining kidney?
Older People Have Special Needs:
A. Zolpidem is on the Beers list of drugs that are often inappropriate for older people. Experts revise this list every few years to help keep doctors from making things worse by prescribing drugs that affect older people badly. (You can learn more from our Guide to Drugs and Older People.)
Is Trazodone Safer?
We’re not sure that trazodone is safer, however. The FDA has never approved this antidepressant for treating insomnia. It can cause next-day drowsiness, dizziness, confusion, dry mouth, blurred vision, unsteadiness and headache.
Getting Off Zolpidem Requires Patience:
Once your doctor decides Ambien is out, you may need several weeks of gradual dose reduction to phase off zolpidem to avoid rebound insomnia. Cognitive behavioral therapy for insomnia helps without side effects. Don’t overlook tai chi, a moving meditation that can be useful.
Non-drug options include dietary supplements such as melatonin, 5-HTP or tryptophan. There is evidence that tart cherry juice can help people fall asleep more quickly and sleep longer (Pigeon et al, Journal of Medicinal Food, June 2010).
You can find details on these and other sleep aids in our Guide to Getting a Good Night’s Sleep. This 22-page online resource is available at www.PeoplesPharmacy.com.
