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Nearly a third of older adults don't get solid zzz's, according to a University of Michigan poll of 1,065 people age 65 and older. To help them sleep, 36 percent report taking a prescription drug, over-the-counter aid or a dietary supplement such as melatonin.
But research suggests the benefits are modest at best. A Consumer Reports Best Buy Drugs analysis found that people taking prescription sleep medications such as Ambien (zolpidem and generic) or Lunesta (eszopiclone and generic) fell asleep only eight to 20 minutes faster than people taking a placebo.
Worse, prescription sedatives and some OTC sleep aids can be risky, especially for older adults, with side effects that can include dry mouth, confusion, dizziness, next-day drowsiness, and impaired balance and coordination.
Taking sleep meds may also cause dependency, increase the risk of car accidents, and more than double the risk of falls and fractures — common reasons for hospitalization and death in older adults, according to Consumer Reports' Choosing Wisely campaign.
Because of these dangers, the American Geriatrics Society includes the potent prescription sleep drugs — Ambien, Lunesta and zaleplon (Sonata) — on its list of medications that adults age 65 and older should avoid.
Compounding those dangers is the tendency for many to use the medications for longer than recommended. In a 2015 Consumer Reports survey of 4,023 U.S. adults, 41 percent of people who used OTC sleep aids reported taking them for a year or longer. Most of these drugs should be taken for just a few weeks or less. That's because mounting evidence suggests that long-term use of certain sleep meds that contain diphenhydramine, found in products including Sominex, Tylenol PM and ZzzQuil; antihistamines such as Benadryl; and some cold and cough medicines may increase the chances of dementia.
You might consider "natural" sleep remedies to be a safer bet, but there's little research to suggest they work — and they cause their share of side effects. For example, melatonin can cause nausea and dizziness, and may interact with blood-pressure and diabetes medications.
In the University of Michigan poll, 54 percent of people 65 and older said they believed poor sleep was a normal part of aging. But that's a harmful misconception, says Preeti Malani, the chief health officer at the University of Michigan.
"If older adults believe that these changes are a normal, inevitable part of aging, they may not think of it as something to discuss with their doctor," Malani adds.
No matter your age, Malani recommends telling your doctor about any sleep concerns during regular checkups. That way, he or she can check for underlying issues that may cause sleep problems, such as anxiety, depression, restless legs and even heart disease.
If your doctor rules out other conditions, Leigh Ann Mike, a clinical associate professor at the University of Washington's School of Pharmacy, recommends first trying to improve your sleep hygiene. Go to bed and wake up at the same time every day, avoid that late-afternoon coffee, limit alcohol and sleep in a dark, peaceful bedroom (no smartphones and tablets in bed).
For chronic insomnia, CR Best Buy Drugs recommends cognitive behavioral therapy as a first-choice treatment. With CBT, you work with a licensed sleep therapist, learning about habits or attitudes that may compromise your sleep and keeping a sleep diary. Studies suggest that CBT helps 70 to 80 percent of people with chronic insomnia, and effects are long-lasting.
Reserve sleep medication for short-term bouts of sleeplessness, such as those caused by jet lag or anxiety after a family death or job loss. Follow instructions closely, use the lowest recommended dose for only a few days at a time, and take these drugs only if you allow yourself at least seven or eight hours of sleep. Avoid drinking alcohol while taking sleep meds. And don't take sleep drugs with other drugs they might interact with dangerously. (These include antidepressants and certain antibiotics.) Use caution if you drive the next day; you might still be drowsy.
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