Sleep and Aging – Sleep Guide for the Elderly
As we age, many of us we will experience certain changes in our bodies that will also affect how we sleep. The effect of these changes may further be influenced by chronic illness or the … Read more
As we age, many of us we will experience certain changes in our bodies that will also affect how we sleep. The effect of these changes may further be influenced by chronic illness or the … Read more
As we age, many of us we will experience certain changes in our bodies that will also affect how we sleep. The effect of these changes may further be influenced by chronic illness or the side effects of prescription medication. Unfortunately, sleep problems and disorders are very common among seniors, and epidemiological studies indicate that most elderly get less than recommended seven or eight hours of sleep. Since many older adults also have problems to fall asleep or stay asleep during the entire night, self-reported studies indicate that many older adults use sleeping pills chronically. Not all sleeping pills are recommended for seniors. In the following sections, you can learn more about sleep changes and problems that occur with aging, what is the best over the counter sleeping aid for older adults, often recommended prescription medications for older adults, alternative options such as natural sleep aids, as well as what sleep aids seniors should avoid.
As adults, when it comes to sleep problems, the most common sleep issue experienced by seniors is insomnia. However, in seniors, insomnia is often secondary rather than the primary disorder. Secondary insomnia means that the sleep problem is brought on by different physiological factors, such as chronic medical conditions and side effects of chronic use of prescription medication. Therefore the best treatment for insomnia in older adults is addressing the primary cause of the sleep problem. Chronic illnesses and conditions associated with secondary insomnia in old age include neurological disorders such as Parkinson’s disease and dementia, heart failure, bladder failure, prostate enlargement, chronic gastrointestinal conditions, and respiratory conditions. Depression, anxiety and other mental disorders are also linked to insomnia, but researchers still aren’t sure whether these disorders cause insomnia or it’s the other way around. Another problem for the elderly is that their sleep architecture changes as they age. Sleep architecture refers to the progression of sleep across the night, and as we age, the amplitude of our circadian rhythm will decrease. This means seniors transition between sleep stages a bit differently than younger adults. Older adults experience lower amounts of slow-wave sleep and higher levels of shallow sleep. Seniors also often have problems with thermoregulation which can further affect their quality of sleep. In the morning, our body temperature should naturally increase and signalize our body and mind that it’s time to wake up. In the evening, a decline in body temperature signalizes it’s time for sleep, and it will make us feel tired and a bit drowsy. When thermoregulation in our body is disrupted, it can lead to circadian desynchronization, putting seniors at risk for insomnia and numerous sleep-onset issues. Lastly, poor sleeping habits can also lead to insomnia. For example, many seniors enjoy taking daytime naps, go to bed too early and rise very early or at irregular times. All these habits can severely affect one’s circadian rhythm and quality of sleep.
In addition to insomnia, older people often have troubles with sleep apnea, narcolepsy, restless leg syndrome, snoring, and even REM sleep behavior disorder. Severe sleep disorders are often treated with prescription sleep pills such as estazolam, rozerem and silenor.
Sleep apnea in elderly is characterized by temporary loss of breath during sleep. The loss of breath can even last for one minute. Since this condition severely affects sleep, it can significantly disrupt the normal functioning of your circadian rhythm. Seniors can either have obstructive sleep apnea (OSA), which affects breathing by obstructing the airway, or central sleep apnea (CSA), which is caused by improper communication between the brain and breathing muscles. Obstructive sleep apnea is much more common, and around 24% of older women and 9% of older men suffer from this sleep disorder. It is important to know that cardiovascular disease is a serious concern for people with sleep apnea. The two conditions are often co-morbid, and older people with one are more likely to acquire the other. Elderly suffering from sleep apnea are also at higher risk for coronary artery disease, and conditions like hypertension, heart failure, stroke, and cardiac arrhythmia.
Narcolepsy is characterized by daytime fatigue and a very strong desire to sleep. Sleepiness can be so intense that it can cause ‘sleep attacks’, during which the affected person will suddenly fall asleep no matter where they are or what they were doing at the moment. Other narcolepsy symptoms include routine hypnagogic hallucinations, cataplexy, and sleep paralysis. However, these severe symptoms occur rarely, and the affected individual mostly has to deal with ‘sleep attacks’.
RLS is often reported by elderly sleepers. The condition is characterized by an itching sensation beneath the skin, accompanied by tingling, cramping or pain. The symptoms usually set in around bedtime and may cause sleep-onset insomnia. Periodic limb movement disorder shares the same symptoms as restless leg syndrome, but the difference is that PLM only affects people during sleep, which can lead to fragmented sleep and circadian rhythm disruption.
Older adults are prone to snoring because the airway muscles that help regulate proper breathing during sleep are weakened. Although snoring doesn’t carry any health-threatening concerns, it is seen as a predictor for more serious problems like stroke or heart disease.
REM sleep behavior disorder is often diagnosed in people over the age of 60. This sleep disorder is often associated with other age-related neurological conditions, such as Alzheimer’s and Parkinson’s disease. People suffering from this condition, unlike healthy individuals, can fully control their muscles during REM sleep. REM sleep is a sleep state when most dreaming occurs. Therefore, seniors with REM sleep behavior disorder often act out their dreams, flail their limbs, stand or walk around, and similar. Some patients may even engage in activities such as eating or bathing.
Self-reported studies show that many older adults use sleeping pills chronically. Not all sleep pills are recommended for seniors, and each category carries a unique set of effects, characteristics and user warnings. In the following sections, you can learn what prescription and OTC sleep tablets for older adults are often recommended to seniors, what are the best sleep medications for elderly, and best alternatives such as natural sleep aids for elderly.
Unfortunately, over-the-counter sleep meds may not be the best choice for treating insomnia in the elderly. Elderly adults will feel the side effects of the drugs much faster. Antihistamine based OTC drugs (Sominex, Nytol, Unisom) and pain relievers such as Advil and Tylenol are one of the over the counter drugs that knock you out, but it’s important to keep in mind that these meds have adverse side effects that you are going to feel much faster than a young adult would. Therefore, it is best to use OTC sleep aids when your quality of life is severely affected, and nothing else worked to treat your problem. If your insomnia is secondary, keep in mind that it’s vital to address its primary cause and that sleep pills probably won’t work. Lastly, before taking a sleep medicine, you must consult with your physician and make sure the sleep drug you intend to use will not interfere with other medications you are using on a daily basis.
When it comes to non-prescription antihistamines, diphenhydramine is the most commonly recommended over-the-counter antihistamine sleep aid. Diphenhydramine can be found in Nytol, Sominex, Excedrin and Tylenol PM. Benadryl contains diphenhydramine, and although it’s primarily used for allergy relief, it can also be recommended as a sleep aid. Another histamine that is proven to help with insomnia is doxylamine found in Unisom sleep aid. Other antihistamines that may be used as sleep aids are chlorpheniramine and hydroxyzine. Apart from antihistamines, some pain relievers such as Tylenol, Advil, and Motrin can be recommended for alleviating sleep-related issues. Tylenol contains acetaminophen which helps to induce sleep but doesn’t cause daytime drowsiness as antihistamines. Non-steroidal inflammatory drugs such as Advil and Motrin can also be recommended as a sleep aid because they contain ibuprofen which also helps to induce sleep.
Many herbal teas and dietary supplements on the market are used to treat insomnia and other sleep disorders. Melatonin is definitely the most commonly used sleep aid supplement. This sleep aid is considered most useful for people with sleep-onset or sleep maintenance insomnia as well as jet lag symptoms. Other widely recommended options include Valerian root and 5-HTP supplements. Natural remedies are considered relatively sleeping aids for elderly.
| TYPE OF OTC SLEEP DRUG | SIDE EFFECTS |
ABUSE POTENTIAL |
| Melatonin supplements | daytime drowsiness, dizziness, stomach cramps, irritability | low |
| Valerian supplements | headaches, nausea, and irritability | very low |
| 5-HTP supplements | abdominal pain, gas, constipation, diarrhea, daytime drowsiness, daytime anxiety and depression. | low |
| Combination sleep aids | daytime drowsiness, dizziness, irritability | low |
| Sominex (diphenhydramine based sleep aid) | daytime drowsiness, constipation, nausea, and difficulty during urination. | low |
| Unisom (doxylamine based sleep drug) | daytime drowsiness, blurred vision, constipation, problems with dry mouth, nose, and throat. | low |
| Chlorphen (chlorpheniramine based sleep aid ) | daytime drowsiness, blurred vision, constipation, problems with dry mouth, nose, and throat. | low |
| Hydroxyzine (antihistamine sleep drug) | dry mouth, nose or throat, dizziness, drowsiness, nausea, headaches | very low |
| Tylenol (acetaminophen based sleep aid) | dizziness, sweating, nausea, loss of appetite, urination issues, bruising or swelling | very low |
| Advil (Motrin) (Ibuprofen based sleep drug) | sweating, nausea, constipation, to rash, ringing in ears, and diarrhea. | very low |
Melatonin is a hormone and a neurotransmitter naturally produced by our body. Many people wonder is melatonin safe for elderly. Melatonin supplements have very low dependency risks, and therefore are the best choice for older adults with sleep issues. Side effects are not common in younger adults, but seniors may experience daytime drowsiness, stomach cramps, and irritability due to prolonged use of melatonin. Melatonin is safe to use, but before taking it, it’s still required to consult with your physician.
Valerian root is found in many natural sleep supplements. Since this is an herbal-based sleep aid, it has very low dependency risks. Although side effects are not common, the use of valerian root can lead to headaches, nausea, and irritability.
5-HTP is also commonly found in many natural and herbal sleep aids and supplements. 5-HTP is a natural precursor to serotonin, and serotonin is vital for sleep regulation because it assists in the production of melatonin. Although the risk of dependency is low, prolonged use may lead to abdominal pain, gas, constipation, diarrhea, daytime drowsiness, daytime anxiety and depression.
Combination sleep aids contain multiple natural and sleep-inducing ingredients such as melatonin, tryptophan, 5-HTP; herbs such as chamomile, valerian, and passion flower, and numerous vitamins and minerals. Dependency risk is very low or non-existent and side effects are rare. However, seniors may experience some side effects, just as when taking melatonin, valerian or 5-HTP supplements. Best natural sleep remedies for elderly are herbal teas such as chamomile, valerian and peppermint tea. These teas will at the same time calm the mind and induce sleep.
Sominex is a diphenhydramine based sleep aid that is a good option for seniors because it has low dependency risks. However, this sleep drug can have many side effects for elderly adults such as daytime drowsiness, constipation, nausea, and difficulty during urination.
Unisom is a doxylamine based sleep drug which has low dependency risk, but also some unpleasant side effects such as daytime drowsiness, blurred vision, constipation or problems with dry mouth, nose, and throat.
Chlorphen is a chlorpheniramine based sleep aid that has low dependency risk but causes side effects very similar to Unisom.
Hydroxyzine is an OTC sleep drug from the group of antihistamines. It is often recommended to seniors due to its very low dependency risk. However, prolonged or uncontrolled use may lead to experiencing side effects typical for all antihistamine medications such as dry mouth, nose or throat, dizziness, drowsiness, nausea, headaches and so on.
Tylenol is an acetaminophen-based sleep aid that is primarily used to relieve pain. However, it can also aid sleep problems such as insomnia. Although it has a very low dependency risk, it has adverse side effects such as dizziness, sweating, nausea, loss of appetite, urination issues, and even unusual bruising or swelling.
Advil contains Ibuprofen, and it’s also primarily used as a pain reliever. As Tylenol, Advil can also help alleviate some symptoms of insomnia and fall asleep faster. The dependency risk is very low, but side effects due to prolonged use can be very severe, from sweating, nausea, constipation, to rash, ringing in ears, and diarrhea. As stated before, the chronic use of sleeping pills in the elderly can lead to undesirable side effects that are generally not reported in younger adult patients. These effects often include the unwanted daytime drowsiness, physical imbalance, incontinence and even impaired memory and alertness. For this reason, it is your best and safest option to opt for low-risk safe sleep aid with minimal side effects like melatonin.
A review of randomized controlled studies over the past 12 years suggests commonly used OTC sleep-aid agents, especially diphenhydamine and valerian, lack robust clinical evidence supporting efficacy and safety – Source
When it comes to prescription pills, older adults are often prescribed benzodiazepine hypnotics and non-benzodiazepine hypnotics. Commonly used benzodiazepines are temazepam, loprazolam, flurazepam, clonazepam, diazepam and so on. Benzodiazepines are considered minor tranquilizers that can be used to and induce sleep and relieve anxiety. Due to the strength of these drugs, seniors typically begin their treatment at half the recommended dose as younger patients. These drugs also exhibit dangerous interactions with alcohol, and you should never mix the two. Non-benzodiazepine sleep pills are better known as Z-drugs. Unlike benzodiazepines, Z-drugs act selectively and affect only the receptors in the brain that help to induce sleep. Overall abuse potential and side effects are significantly less pronounced than when using benzodiazepine drugs. Most commonly prescribed Z-drugs are Ambien (zolpidem), Lunesta (zopiclone) and Sonata (zaleplon). Ramelteon (Rozerem) is also used very often. Rozerem is not a Z-drug, but it acts in a very similar way. Rozerem is one of the best alternatives to Ambien for elderly. Ambien is a good sleep aid, but since it works by suppressing the nervous system (and make you fall asleep), it also causes mental confusion, fogginess, and drowsiness. Many seniors also report serious side effects, even when used as directed, such as the potential for engaging in activities such as driving, having sex, losing memory and so on. This drug is also habit-forming, and it is best to use it only for a short period of time. There are several pharmaceutical alternatives to Ambien such as Lunesta and Sonata, but these sleep aids also have their own risks and side effects. Rozerem may be the best alternative option because it’s not habit forming and rarely causes side effects. Apart from falling into the category of safe sleeping pills for elderly, it’s also considered one of the best prescription non-addictive sleep aids for older adults. For more information about best prescription sleep aids, doses, recommendations, and risks, check out our page about best sleeping pills.
You should know that taking sleeping pills should always be combined with healthy sleeping habits.
Sleep schedule: In order to improve your sleep hygiene and ensure a healthy circadian cycle every night, you should create a sleep schedule and strictly stick to it. Humans are creatures of habit and bedtime routines don’t only work great for kids.
Activity: In order to quickly fall asleep at night, you should be active during the day. Many seniors have too many or too long daytime naps that affect their quality of sleep at night. Light physical activity is also great for winding down at the end of the day and feeling more tired in the evening.
Vitamin D: If you spend too much time inside, make sure you also go outside and expose yourself to bright sunlight. You need your daily dose of vitamin D. If you can’t spend 30 to 60 minutes in direct sunlight every day due to a cold climate or some other reason, consider taking vitamin D supplements.
An interesting fact is that vitamin D deficiency is linked with the severity of obstructive sleep apnea in adults.
“Vit D levels were lower in OSAS patients compared with non-apnoeic controls. Several indices of OSAS severity also correlated with Vit D levels.”
Bathing: Taking a bath before bed is not only great for relaxing yourself from a stressful day, but also for aiding thermoregulation. Since many seniors have problems with regulating their body temperature, a warm bath may be perfect for preparing yourself for bed.
Fluid intake: It’s important to stay hydrated during the day, but you should avoid drinking anything close to bedtime, especially if you have problems with incontinence. An hour before bed, fluid intake should be kept to a minimum.
Sleep sanctuary: For healthy and quality sleep, your bedroom must be properly ventilated, dark and reasonably cool. Your bed should be comfortable, but also provide quality back support. Avoid all bedroom activities that hinder sleep. Basically, the bedroom should be used only for sleep and sex. This will help your brain to associate the room with sleep which will help you to hit the hay more quickly.
A wannabe journalist who somehow ended up as an art historian. She is a gamer, a coffee addict and a sleep aficionado. When she is not researching about sleep and finding out new ways to fight off the insomnia beast, she's spending time with her friends, gaming or visiting local museums.
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