In the elderly, should prescription medication be necessary, the first-line treatment is nonbenzodiazepines (e.g., zolpidem, eszopiclone, zaleplon, and ramelteon) as they have been found to be safer and better tolerated than tricyclic antidepressants, antihistamines, and benzodiazepines.
In the elderly, nonbenzodiazepines such as zolpidem, eszopiclone, zaleplon, and ramelteon are safer and better tolerated than tricyclic antidepressants, antihistamines, and benzodiazepines. Pharmacotherapy should be recommended only after sleep hygiene is addressed, however.
Melatonin: Melatonin is considered one of the safest over-the-counter sleep aids, with few side effects. A prescription drug called ramelteon is designed to mimic the effects of melatonin. Like melatonin, it is not considered habit-forming and it does not affect balance.
Suvorexant or low-dose doxepin can improve sleep maintenance. Eszopiclone or zolpidem extended release can be utilized for both sleep onset and sleep maintenance. Low-dose zolpidem sublingual tablets or zaleplon can alleviate middle-of-the-night awakenings. Benzodiazepines should not be used routinely.
Antihistamine sleep-aids (like doxylamine succinate and diphenhydramine) are largely considered to be “non-habit-forming,” because they do not cause physical dependence.
One study of older adults with insomnia found that magnesium supplementation at a dose of 500 milligrams daily for eight weeks helped them fall asleep faster, stay asleep longer, reduced nighttime awakenings, and increased their levels of naturally circulating melatonin.
Rozerem can be prescribed for long-term use, and the drug has shown no evidence of abuse or dependence. Suvorexant (Belsomra): It works by blocking a hormone that promotes wakefulness and causes insomnia. It is approved by the FDA to treat people that have insomnia due to an inability to fall asleep or to stay asleep.
The most common antidepressants prescribed for sleep are Trazodone, Doxepine, and Elavil. These medications are usually prescribed at doses that are lower than what is required for the treatment of depression and they do not lead to tolerance or drug dependence.
The most common side effects are headaches, nausea and dizziness (17). In the elderly, exogenous melatonin may decrease blood pressure and cause hypothermia (17).
Cognitive behavioral therapy for insomnia (CBT-I) is the preferred first-line treatment for chronic insomnia in adults and has been endorsed as first-line therapy by multiple societies and guideline panels [1-5]. Overall, the evidence base is stronger for CBT-I than for medications.
Sleeping pills work best and are safest if you use them for a short time along with lifestyle changes. Research shows that lifestyle and behaviour changes are the best long-term choice to help you sleep well. Sleeping pills may have side effects, such as daytime drowsiness and nausea.
The researchers found that those who were prescribed more than 132 doses of these hypnotic drugs per year—meaning those patients taking them at least every two or three days—had a 35% increase in cancer risk and a five-fold jump in risk of death compared to those not prescribed these drugs.
Generally, magnesium glycinate is recognized as the best form of magnesium to help with sleep because it's easy for the body to absorb. Though the effects of magnesium on sleep are not completely known or understood, some believe that its effects on muscle contraction and nervous system regulation help improve sleep.
As you age your body produces lower levels of growth hormone, so you'll likely experience a decrease in slow wave or deep sleep (an especially refreshing part of the sleep cycle). When this happens you produce less melatonin, meaning you'll often experience more fragmented sleep and wake up more often during the night.
Traditionally, the “elderly” are considered to be those persons age 65 and older.
Sleep and Aging
Older adults need about the same amount of sleep as all adults—7 to 9 hours each night. But, older people tend to go to sleep earlier and get up earlier than they did when they were younger. There are many reasons why older people may not get enough sleep at night.
Melatonin is generally regarded as safe for seniors by physicians and pharmacists because its side effects are mild, it's not habit forming, and it does not cause withdrawal symptoms if you stop taking it suddenly.
Melatonin is generally considered safe to take every night at doses between 0.5 mg and 5 mg. A safe starting dose of melatonin is between 1 mg and 5 mg for adults. More melatonin can cause side effects, particularly in older adults. For older adults, lower doses, such as 1 mg, are usually considered enough melatonin.
Do not use melatonin if you are pregnant or breastfeeding or have an autoimmune disorder, a seizure disorder or depression. Talk to your health care provider if you have diabetes or high blood pressure.
The bottom line
In January 2022, the FDA approved Quviviq (daridorexant) to treat insomnia in adults. This medication can be helpful both for falling and staying asleep. Studies suggest it's both safe and effective. Most people tolerated daridorexant well in studies.
Why are doctors reluctant to prescribe sleeping tablets? are known to have more accidents (e.g. falls and car-related incidents), therefore it may not be safe to drive or operate machinery. Older people taking sleeping tablets have an increased risk of falling and sustaining bone fractures (e.g. hip injury).
Side effects of prescription sleeping pills
Dizziness or lightheadedness, which may lead to falls. Headache. Diarrhea or nausea. Prolonged drowsiness, more so with drugs that help you stay asleep.
For chronic or clinical insomnia, prescription medications can help. Classes of prescriptions sleep aids include benzodiazepines (Halcion, Restoril), antidepressants (Silenor, Trazodone), melatonin-receptor agonists (Hetlioz, Rozerem), and sedative-hypnotics (like Ambien, Lunesta, Belsomra).