Do you have trouble sleeping? That’s just a natural outcome of accumulating lots of birthdays, right? Actually, insomnia is not a normal consequence of aging. According to the National Poll on Healthy Aging, however, half of older adults are convinced that sleep problems “come naturally with age.” Many think that sleeping pills for seniors are a simple solution to insomnia. Whether it’s clonazepam, diphenhydramine, lorazepam, zolpidem or zaleplon, a lot of seniors believe that they can’t get a decent night’s sleep without some pharmacological help.
Older People Gobble Down Sleeping Pills:
The pollsters at the Univeristy of Michigan Institute for Healthcare Policy and Innovation discovered that more than one third of those over 65:
“…reported using some type of medication to help with sleep including prescription sleep medications, over-the-counter (OTC) medications promoted as night-time formulations, herbal/natural sleep aids (like melatonin) or prescription pain medications.”
Not surprisingly, people who reported they frequently had trouble getting to sleep were even more likely to take such medication. Almost one third use their medicine regularly, with another third using it occasionally. A majority of those taking prescription sleeping pills had been taking them for years.
A Short History of Sleeping Pills:
People have been told for generations that getting a good night’s sleep is essential for good health. That leaves many insomniacs worrying that sleep deprivation could increase their risk for dementia, depression, hypertension, diabetes, weight gain and reduced immunity.
Barbiturates:
If they complain to their doctors about insomnia, they might get a prescription for a sleeping pill. Historically that would have likely been a barbiturate like amobarbital (Amytal) or secobarbital (Seconal). Such sedatives were easily abused, and some high-profile deaths occurred when these drugs were combined with alcohol.
Benzodiazepines:
The next generation of popular sleeping pills belonged to the benzodiazepine class of medications. Drugs such as alprazolam (Xanax), clonazepam (Klonopin), estazolam (ProSom), flurazepam (Dalmane), temazepam (Restoril) and triazolam (Halcion) have all been prescribed for insomnia.
The trouble with such prescriptions is that the official prescribing information often cautions doctors to prescribe them for a short period of time, such as a week or two. Many people with chronic insomnia need longer lasting solutions.
Another drawback of benzos is that they can lead to dependence. When people rely on such medications either for anxiety or for insomnia, they may find it difficult to stop without suffering withdrawal symptoms.
Z-Drugs:
This leads us to the category of sleeping pills called Z-drugs. That’s not because they help you get your ZZZs, although they can help people fall asleep. All of their generic names contain a z: zolpidem (Ambien, Edluar and Zolpimist), zaleplon (Sonata) and eszopiclone (Lunesta).
An FDA article (March 6, 2024) titled “TakingZ-Drugs for Insomnia? Know the Risk“ draws attention to a disturbing complication linked to these medications:
“What Are Complex Sleep Behaviors?”
The FDA articles goes on to describe this alarming reaction to Z-drugs:
“Complex sleep behaviors occur while you are not fully awake. Examples include sleepwalking, sleep driving, sleep cooking, or taking other medicines.
“The FDA has received reports of people taking these insomnia medicines and accidentally overdosing, falling, being burned, shooting themselves, and wandering outside in extremely cold weather, among other incidents.
“People might not remember these behaviors when they wake up the next morning. Moreover, they may experience these types of behaviors after their first dose of one of these Z-drugs, or after continued use.”
Readers Report Their Own Reactions to Z-drugs:
Readers of this column have described how devastating these events can be. Some are concerned about a loved one:
“My husband has been taking Lunesta every night for about two years. I have witnessed episodes of sleep driving and other bizarre behaviors. He doesn’t believe that these things have happened, and it has caused a huge strain on our relationship. I’m so afraid that someone will get hurt before he believes he has a problem with this medication.”
Others report their own experience, like this person:
“I got a DWI for sleep driving while taking Ambien. I lost not only my driver’s license but my career. I never misused the drug, but I lost my job because of it.”
One woman had been taking zolpidem for several months:
“I started noticing empty cracker and cereal boxes in my bed in the morning and had NO clue I had eaten them. I woke up one morning to make lunch for work and found my lunch already made. I had no recollection of doing that.
“My friends made comments on my odd emails in the middle of the night and phone calls that sounded strange. Then the worst happened. I crashed my car and didn’t even know I was driving.”
Commercials Make Sleeping Pills for Seniors Seem Natural:
It’s hardly any wonder that millions of people pop a sleeping pill every night. No one can predict which night will pose an insomnia problem. As a result, lots of folks swallow a sleeping pill “just in case” they might have trouble falling asleep.
TV commercials may reinforce the idea that insomnia can cause cognitive impairment. People are encouraged to take a medicine that will help them fall asleep and remain asleep. The pills are supposed to allow people to awaken refreshed. What a lovely picture the ads paint.
Sleeping Pills for Seniors: A Darker Picture
Regular use of many sleeping medications can have serious consequences for older adults. One of the more popular prescription sleeping ingredients has been zolpidem (Ambien, Ambien CR, Edluar, Zolpimist).
People over 45 account for three-fourths of the emergency department visits due to adverse effects of the sleeping pill zolpidem (The CBHSQ Report, May 2013). The authors note:
“Adverse reactions have occurred, including daytime drowsiness, dizziness, hallucinations, behavioral changes (e.g., bizarre behavior and agitation), and complex behaviors such as sleepwalking and ‘sleep driving’ (i.e., driving while not fully awake). When zolpidem is combined with other drugs that depress the central nervous system–such as anti-anxiety medications (e.g., benzodiazepines), narcotic pain relievers, or alcohol–the sedative effects of zolpidem can be dangerously enhanced.”
Sleep Walking, Sleep Driving, Sleep Eating:
Most of us find it hard to imagine someone would take a sleeping pill, go to bed and then end up in an automobile accident. And yet we have heard from lots of people who are totally amazed to discover that is what happened to them.
M.S. shared this story:
“My wife, who is very responsible and would never drink and drive, was arrested for DUI after leaving the scene of an accident she never remembers being in.
“She was having chronic sleep issues and got a CPAP machine. Her doctor gave her a 10 mg script for Ambien. We found out from doing research that the FDA said women should not be given 10mg doses!
“Her PBT and blood tests showed a high alcohol content in her system. She remembers taking only one drink. She has never been drunk. If she did drink, it would have maybe been one beer at home or one drink at a restaurant. She drives for a living and would never risk losing her license.
“When they upped her dose of Ambien she always seemed groggy all day. We found out after this incident that she had many memory lapses as to events, people she had contact with etc. It is as if she was in a zombie state for much of that time.
“After this incident she threw the sleeping pills away and has now become clear headed again.”
Barbara in Kansas City, MO had a scary sleep driving episode:
“I took Ambien 10 years ago for about 2 months. I drove 30 miles through town, I remember leaving my house and the next thing I knew I was parked in front of a book store with a police officer knocking on my window. To my surprise there were 6 officers surrounding my car. They said I stopped at all the lights, didn’t break any traffic laws, but he thought I was asleep.”
Ed in Ohio had a close call:
“I woke up in the ER, not knowing how I got there. It took over a day to get the full story.
“The last thing I remember is taking a 10 mg Ambien and going to bed. The story goes that someone in my building saw me stumbling around and called the police. EMTs came and searched my room. The Ambien bottle was empty, but I just filled the script that day. So they assumed I took them all and got me pink- slipped at the ER for attempted suicide. I could have taken them all.
“I have zero memory after going to sleep. So I’m waiting to explain the situation to the shrink so I can get out of here. This sucks. I’m on day 2 in here. I could have been driving and killed someone.”
Margaret in Georgia also had problem:
“I tried zolpidem several years ago but had some BAD side effects from it. My daughters would find me in the kitchen fixing food while sleep walking.
“One time my oldest had to hide the car keys from me because I wanted to drive somewhere – while sleep walking! When I found out about it the next day I threw away the rest of the zolpidem and never took it again.
“Now my husband is taking it and is doing the same things. He is getting up during the night and fixing food, waking up our youngest daughter to ask her if she called him.
“Just last night he fixed some soup on the stove and made a huge mess, woke our youngest again, had all the lights on in the living room and kitchen, cleaned out the coffee maker, and took the dog for a walk – in the middle of the night! We live on the 2nd floor of our building without an elevator, and he’s on blood thinners so if he falls he could bleed to death without anyone knowing. This morning I took away his zolpidem and won’t give it back. He’s not safe while on it!”
Other Sleeping Pill Side Effects:
Side effects of hypnotics (doctorspeak for sleeping pills) may include dementia and serious injury due to falls (Clinical Therapeutics, Nov. 2016).
Joyce in Asheville, NC had trouble getting up:
“I have been on zolpidem for many years. I had maybe 3 incidents where I got up during the night to go to the bathroom. When going to sit on the toilet I ended up on the floor! It took me several minutes to be able to get up, and refused my husbands help, mostly
due to embarrassment.“I do have memory issues sometimes. I don’t know if it due to the zolpidem or age.”
OTC Sleeping Pills for Seniors and Brain Fog:
People who are aware of the hazards of relying on prescription sleeping pills like zolpidem may turn to over-the-counter sleep aids. Unfortunately, a number of OTC medicines for sleeping contain diphenhydramine, a sedating antihistamine.
Diphenhydramine also has serious drawbacks for older individuals. This drug has strong anticholinergic activity and can lead to confusion, grogginess and memory loss.
Older people who do not want to ask their doctors about prescription sleeping pills may find it easy to access “PM” pain relievers. The pain part of the pills may include ibuprofen, naproxen or acetaminophen. And when you accumulate lots of birthdays the pain of arthritis is not uncommon.
The PM part usually equals diphenhydramine (DPH for short). It is a very sedating antihistamine. If you have ever taken Benadryl for allergy symptoms you know what it feels like to take diphenhydramine. We frequently describe it as a sluggish, spacey feeling. Drug companies have discovered that this sedative side effect is a fabulous opportunity to market PM pain relievers.
There are now so many of these products we have lost count. For starters, there’s Tylenol PM. A TV commercials points out that when you “don’t get enough sleep and your body aches, you’re not yourself.” We see a mom pouring breakfast cereal on the floor and in a juice glass instead of in a bowl. Another woman puts coffee beans in dog’s food bowl. The kicker is the mom who is trying to change the channel on the TV with a remote control device that instead is opening and closing the garage door. The answer:
“Tylenol PM relieves pain and helps you fall fast asleep and stay asleep.”
Other PM pain relievers include Advil PM, Aleve PM, Bayer PM and Excedrin PM. DPH has strong anticholinergic activity. That means it affects the way the brain deals with a critical neurotransmitter called acetylcholine. Some people complain about brain fog associated with anticholinergic drugs.
An article in JAMA Neurology (June 1, 2016) concluded:
“The use of AC [anticholinergic] medication was associated with increased brain atrophy and dysfunction and clinical decline. Thus, use of AC medication among older adults should likely be discouraged if alternative therapies are available.”
Another article in JAMA Internal Medicine (March, 2015) concluded:
“Higher cumulative anticholinergic use is associated with an increased risk for dementia. Efforts to increase awareness among health care professionals and older adults about this potential medication-related risk are important to minimize anticholinergic use over time.”
We’re not saying that occasional use of any of the PM pain relievers will lead to dementia or Alzheimer’s disease. But when someone takes diphenhydramine regularly and combines it with other anticholinergic drugs it can lead to a large anticholinergic body “burden.” Learn more about which drugs have anticholinergic activity at this link.
Trazadone Sleeping Pills for Seniors:
One popular prescription sleeping pill for older people is trazodone. Even though the FDA has never approved this old-fashioned antidepressant for insomnia, many primary care providers prescribe it off label for people who have a hard time falling asleep.
Trazodone is not innocuous, however. It may cause morning hangover. Dizziness, constipation, blurred vision and dry mouth are also fairly common. Liver injury, hypertension, glaucoma and abnormal heart rhythms are among its serious complications.
One reader reported her spouse’s experience:
“My husband had difficulty sleeping and was prescribed trazodone. For most of the next day, he was like a zombie from the Living Dead — brain fog, confusion, foot shuffling and disorientation. When he stopped taking the trazodone, we realized that all these nasty after-effects were due to the drug.”
The People’s Pharmacy Perspective:
People with chronic sleep disturbances should discuss this problem with their primary care provider. Cognitive behavioral therapy for insomnia can be very helpful without causing adverse effects.
You will find many natural approaches to overcoming insomnia in our Guide to Getting a Good Night’s Sleep. Some people find melatonin helpful. Others like a glass of tart cherry juice before bedtime. People who have to get up several times for bathroom visits report that eating a handful of raisins in the evening can help. Access to this digital resource is available online at www.PeoplesPharmacy.com.
Share your own sleeping pill experience below in the comment section.
