Sleeping pills and older people: the risks

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.

• 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
  

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 problematic^1,8 – 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

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

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.
  

Regulate your sleep^1,7,9,10

• 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^1,7,9,10

• 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^1,7,9,10

• 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.

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

• Sleep Health Foundation, telephone (02) 8814 8655
• Sleep Disorders Australia, telephone (02) 9990 3514
  
• Reconnexion (formerly TRANX), telephone 1300 273 266