The dangers of sleeping pills

Aging, Fall, 1994

Because sleep is less sound as people age and half of all people over 65 experience some form of sleep disruption -- many seniors think they need to take sleeping pills. While small amounts of these medications can help in a crisis, many older people are taking too many of the prescribed pills for months or years on end or combining them with other medications. The result can be a drug reaction that looks like dementia or psychosis. If the problem is misdiagnosed, an elderly person may be sent to a nursing home prematurely.

Most prescription sleeping pills -- including Dalmane, Doral, ProSom, Restoril, and Halcion -- belong to a class of drugs called benzodiazepines which also includes the tranquilizers, Valium and Xanax. According to experts, all the benzodiazepines could cause "next-day memory loss," to some degree, and the elderly tend to be more susceptible to this side effect. People can also develop a tolerance to these drugs and require higher and higher doses, making serious side effects more likely -- including increased nervousness, anxiety and depression.

The dangers of Halcion, in particular, have become widely publicized. Halcion is the most commonly prescribed sleeping medication in the country (more than 7 million prescriptions were written for Halcion in 1992). According to an article in the January, 1992 issue of The Johns Hopkins Medical Letter, Health After 50, the drug is popular because it's quick acting and doesn't leave users groggy in the morning, as do most other sleep medications.

However, some experts have questioned Halcion's safety. The article notes that several studies have found that instead of producing sleepiness, Halcion can make users "more excitable, confused and anxious the next day," and in a few cases, the drug "has even been reported to be associated with violent behavior." Experts believe that adverse effects of Halcion occur when people develop a tolerance to the drug and overuse it.

A study by the Philadelphia Department of Aging of low-income elderly enrolled in a state program that pays for prescription drugs showed that 80% of the 14,500 people taking Halcion were exceeding the maximum cumlative dose and 70% had far exceeded the recommended duration of two to three weeks. Some experts recommend that dosages be cut in half for elderly people. "We recommend that people use sleeping pills only every third or fourth night," advised Dr. Doral Bliwise, director of the sleep and aging program at Stanford University in an article that appeared in the January-February, 1992 issue of Mature Outlook magazine. "You don't want to get into a pattern of taking pills every night," he said. "People can develop a tolerance to the pills in a week or a month." Experts also know that sleeping pills deprive people of deep sleep and make sleep less restorative over time. Dr. William Dement, director of the Stanford University Sleep Disorders Clinic and Research Center, agrees that there is no medical justification for the chronic use of sleeping pills. He usually prescribes them for "1 or 2 nights and rarely more than 10 nights," he said in a February 2, 1992, article on drug-induced sleep in The New York Times.

Non-prescription sleeping pills cause drowsiness because they are antihistamines. Although they may not cause side effects in younger people, in older people these over-the-counter pills can cause dryness, constipation and confusion.

As people age, the amount of time spent in the deepest stages of sleep decreases, and it is typical for many older people to awaken several times a night but then go back to sleep. Insomnia, however, "is not an inevitable part of aging," according to the National Institute on Aging. NIA says insomnia means "taking a long time to fall asleep (more than 30 to 45 minutes), waking up many times a night, or waking up early and being unable to get back to sleep."

Researchers caution that sleeping pills aren't the answer to chronic sleeplessness. It is important, they say, to remember that insomnia is a symptom of a problem, not the problem itself. Underlying causes of insomnia include depression and psychosocial problems, pulmonary disease, arthritis, prostatic disease, pain, periodic limb movements, and sleep apnea. Sleep apnea, which can be fatal, causes repeated cessations of breathing for 10 seconds or longer. By age 70, 1 in 4 people have some degree of apnea, with the illness most common in men, especially those who are over-weight and who snore loudly.

Because insomnia can have such a serious impact on the quality of an older person's life, it is a problem that should be carefully evaluated by a physician. One medical journal estimated that a doctor needs to spend 45 minutes with a patient to diagnose the problem accurately.