It is no secret that older individuals may struggle more with insomnia than any other group. This is due to a variety of physiological changes that make it harder to get a good night's sleep. 

For most insomniacs, the best solution is a pharmaceutical intervention. However, for older adults, sleeping pills may not be the best first-line solution. This is due to the fact that sleeping pills have more adverse reactions and increased risks for older adults, than they do for other populations. Continue reading for more information on how sleep aids affect older adults. 

Sleeping Changes in Older Adults 

Older adults begin to experience sleeping changes for a variety of physiological reasons. One reason is an altered sleep architecture. Sleep architecture is the progression through the four sleep stages, and how long a person spends in each one. There are for non-rapid eye movement stages and one rapid eye movement (REM) stage. 

As individuals age, they spend less time in NREM stage 3, which is the deepest stage and the one required to feel restored and rejuvenated. 

Sleep schedules are also determined by exposure to light. Low light signals to the brain to release melatonin, which causes the body to prepare for a night's sleep. Light decreases the production of melatonin and increases the release of cortisol, a stress hormone that is also responsible for initiating all of the other processes to start the day. As individuals age, their eyes become less sensitive to changes in light, so it can be hard to regulate their sleep schedule to the 24-hour circadian rhythm. 

In women, specifically, hormonal changes can cause interrupted sleep schedules. Hot flashes and other general discomfort can make it very difficult for women to get the sleep that they need. 

There are a variety of reasons why older adults don't get the sleep that they need, so it is no wonder why they are seeking something to help alleviate these sleeping troubles. However, pharmaceuticals and sleeping pills may not be the best answer for this age group. 

Why Sleeping Pills Don't Work 

Sleeping pills for insomnia in the geriatric population may not help much. Studies show that those who take sleep drugs sleep just a little bit longer than those who do not take them, on average. 

They can also have serious or even deadly side effects for the population of 65 and older. All sedative-hypnotic drugs have special risks for older adults. They are more likely to be more sensitive to the drugs do to prolonged exposure and reduced clearance or metabolism of the drugs. This can increase the drugs' affect, and unless the dose is adjusted, can lead to some serious side effects. 

In addition to toxicity risks, sleep aids can also increase the fall risk in older individuals. Falling as an older adult can cause more problems than falling as a young adult due to decreased ability to heal, altered balance and proprioception, and increased susceptibility to fractures and surgical complications. 

These drugs also increase the risk of car accidents. Due to all of these risks, they do not outweigh the benefits of finding alternative methods or underlying reasons for the insomnia. 

Kinds of Sleeping pills and associated risks 

Barbiturates 

Barbiturates are sedative drugs that that end with "barbital". They are commonly used for surgeries and anesthesia, and very rarely used as sleep aids. Barbiturates are habit forming, meaning you can become tolerant and dependent on them. This means you need a greater amount of them, over time, to achieve the same effect. Due to their sedative effect, they can increase the risk of falls in elderly and overdose because of the altered drug metabolism in adults. If these drugs are stopped abruptly, they can also lead to withdrawal. 

Benzodiazepines 

Benzodiazepines are sedative drugs used for sleep and/or anxiety. They end with "pam" and are also habit forming. They are less dangerous and risky than barbiturates, but still pose similar risks of increased chance of falling and dependence. It is important to speak with your doctor if you are prescribed either one of these about the best way to be safe and ensure that you are not overdosing or increasing your chance of having a negative effect of the drug. Abrupt withdrawal of this drug is also linked to withdrawal, similar to alcohol withdrawal. 

"Z" drugs 

Z drugs are the new sleep aids on the market, that originally, were evaluated to be safer than the other sleep aids. However, they have quickly found that not to be true, as these drugs also posse their own safety concerns. 

Drugs like ambien, lunesta, and sonata (Zolpidem, Eszopiclone, and Zaleplon, respectively) fall into this class of drugs. They seem to pose just as much, or even more risk than older sleep drugs. It is important that if you are prescribed these, then you go right to sleep after taking them to avoid accidents and dangerous actions like driving. 

Over the Counter 

Over the counter medications may not be a good solution either. Medications like Unisom, Benadryl, Advil PM and Tylenol PM can be very bothersome for some seniors. Because of their slow clearance, they can cause a lot of next-day drowsiness as it takes longer for them to wear off. Also, due to their anticholinergic effects, they can cause confusion, constipation, dry mouth and difficulty urinating.

Older adults may already have difficulty voiding (especially men with benign prostatic hypertrophy and women with vulvovaginitis), digesting and defecating, and other physiological processes important for regular function. Adding a medication that interrupts these processes can further complicate existing conditions, as well as increase risk for infections, hemorrhoids, and general discomfort.  

When to Try Sleeping Pills 

Before trying sleeping pills, it's important to try and identify the root cause of your sleeping problems. Rule out underlying anxiety, depression, thyroid dysregulation, heart disease, and any other medical problems that could be the cause. If you are having trouble breathing at night, there could be underlying heart or vascular problems. If you are having strange nightmares, then low blood sugar could be the culprit. Keep a sleep journal to really keep track of your day and associated nighttime activity so your physician can have more information to try and identify what may be causing your trouble with sleep. 

If sleeping problems are primary, meaning they are not caused by anything else, and are truly disruptive to your day-to-day function, then temporary sleep aids may be a viable option. It's important to really talk to your doctor about the pros and cons of these sleeping pills and how to best reduce your risk for an adverse event. 

https://www.choosingwisely.org/patient-resources/treating-insomnia-and-anxiety-in-older-people/