Sleeping Pills and Seniors: Risks and Alternatives

By Andrea Bartels CNP NNCP RNT Registered Nutritional Therapist 16 Nov 2023

Sleeping Pills and Seniors: Risks and Alternatives

Do you know a senior who has trouble falling asleep or staying asleep? Although lifestyle modifications are considered the most effective way to resolve chronic sleeping problems, adopting new lifestyle habits late in life can be challenging. No wonder many choose to take a pill. In fact, about 10 percent of elderly Canadians use sleeping pills regularly.  But sleep medications have numerous side effects and carry additional risks for seniors. What are they? What are some of the safer alternatives? 

In seniors, use of sleeping pills is associated with a risk of falling and the injuries that result: bone fracture, bruising or concussion.  In fact, one study found that 33% of the hip fractures that occur in elderly individuals 85 years of age and older were linked to sleeping pill use.  This is concerning because hip fractures involve a long convalescence that can expose patients to infectious disease in a community care setting. 

Sleeping pills can also exacerbate memory problems. That’s because the benzodiazepine drugs such as alprazolam (Xanax^TM), diazepam (Valium^TM) and lorazepam (Ativan^TM)  inhibit rapid-eye movement (REM)--also known as dream sleep. So if you thought dreaming was an inconsequential or redundant part of your sleep cycle, realize that REM is a stage of sleep that’s essential for learning and memory formation.  

Then there’s the danger of falling asleep at the wheel.  Since they’re sedatives, sleeping pills have been associated with impaired driving the morning after they’re taken. 

These heavy-hitters also come loaded with side effects: dizziness, headaches, GI upset, prolonged drowsiness, daytime memory and performance problems, sexual dysfunction, hallucinations, agitation, and even suicidal thoughts have been reported by users. 

There’s also risk of addiction. Most sleeping pills are only designed to be taken at the lowest dose for the shortest duration possible.  Trouble starts if they are used continuously for more than 2 to 4 weeks, or taken at higher doses, they can become addictive. In other words, the individual taking one of these drugs is at risk of becoming dependent on them because with these drugs, tolerance builds quickly--leading to the consumption of higher and higher doses to achieve the state of calm they’re looking for. This in turn increases a series of risks to physical and mental health. 

Withdrawal: Stopping a benzodiazepine regime suddenly can potentially cause withdrawal effects such as REM sleep rebound--characterized by increased dreaming activity. This can bring on nightmares, or sleepwalking.  That’s why individuals currently using one of these drugs should be supervised by their prescribing physician while tapering off the medication. 

Even the over-the-counter medications marketed for sleep come with side effects. Many people would be surprised to learn that the active ingredients in products like ZzzQuil^TM and Sleep-eze^TM are actually the same drugs used to alleviate allergy symptoms. That’s right:  diphenhydramine HCl and dimenhydrinate are anti-histamines. If you’ve never used them you may not expect Benadryl^TM and Gravol^TM  to have a sedating effect---but they too have been used as sleep aids because their active ingredients are the same. 

Anti-histamines may help get you to sleep in a temporary situation, but they aren’t going to be a great choice for long term use for 2 reasons. For one,  side-effects can include urinary retention, dry mouth, and an altered mental state (for example, sleep walking). 

Another problem with using anti-histamines as a sleep solution is that they soon become less effective. Many users report that they need to take higher and higher dosages to induce their much sought-after sedation. In fact, tolerance has been observed in just a few weeks. After that, the drug becomes ineffective and the individual turns to the stronger, prescription medications with even more serious risks. 

What do both prescription and over-the-counter sleep medications have in common? Experts agree: taking sleeping pills has a negative effect on sleep quality. That’s why other, less problematic options should be considered. Here are a few: 

Magnesium glycinate is a magnesium compound that nourishes the nervous system with the essential mineral magnesium attached to the amino acid l-glycine. Taking magnesium an hour before bedtime supports sleep because of its relaxing effect on the nerves and muscles. For better bowel tolerance, make sure your magnesium glycinate contains at least 70 percent fully-reacted magnesium, and no more than 30 percent magnesium oxide and glycine dry chelate blend. Pure Lab’s Magnesium Glycinate is available in capsules and in 2 powdered forms: regular unsweetened and also, as a flavoured, sweetened drink mix. 

L-Theanine is an amino acid first discovered in green tea. It promotes relaxation without sedation, making it safe to take day or night. It calms the busy brain, helping focus the mind by inducing alpha brain waves. The bonus?  L-theanine has no known toxicity and may be taken by individuals on prescription medications without concern of contraindications. 

For trouble falling asleep, look for a chewable format of l-theanine that can be taken 15 minutes before you hit the pillow.  For individuals who wake up during the night and can’t fall back to sleep, consider taking a slow-release form of l-theanine at bedtime. This format allows for a slower absorption of l-theanine with a more sustained benefit during the night. 

Magnesium and l-theanine make a great pairing for those with sleeping difficulties, but sometimes some additional help is needed. Melatonin is a hormone the human body makes and releases to make us sleepy. But as we age, the secretion of melatonin dwindles, making it hard to fall asleep. Taking a supplemental melatonin product can be very helpful. Unlike sleep drugs, melatonin does not cause withdrawal or dependency symptoms, nor cognitive decline.

Melatonin can be taken 1 hour before bedtime by those who have trouble falling asleep.  A slow-release format is best taken right at bedtime for those who tend to wake up during the night.

References 

Anghel L, Baroiu L, Popazu CR, et al. Benefits and adverse events of melatonin use in the elderly (Review). Exp Ther Med. 2022;23(3):219. 

Auld, Alison. “Researchers take aim at Atlantic Canada’s high rate of sleeping-pill reliance”. Dalhousie University Dal News, January 25, 2021.

Benson, Dana. “Trouble Sleeping? Experts say skip antihistamines.” Baylor College of Medicine June 28, 2021.

CAMH. “Sleep Disorders - Pharmacotherapy”. 

Drugs.com. “Benzodiazepines”. April 14, 2023.

Hassinger AB, Bletnisky N, Dudekula R, El-Solh AA. Selecting a pharmacotherapy regimen for patients with chronic insomnia. Expert Opin Pharmacother. 2020;21(9):1035-1043. 

Mayo Clinic. “Prescription sleeping pills: What’s right for you?”  Accessed online Nov. 7, 2023.

Pagel JF, Parnes BL. Medications for the Treatment of Sleep Disorders: An Overview. Prim Care Companion J Clin Psychiatry. 2001;3(3):118-125.