Are there safe sleep aids for seniors?

6 answers | Last updated: Nov 04, 2016
Lakelover asked...

Are there effective safe sleep aids for seniors with sleep problems not due to other medications?

Expert Answers

Kenneth Robbins, M.D., is a senior medical editor of He is board certified in psychiatry and internal medicine, has a master's in public health from the University of Michigan, and is a clinical professor of psychiatry at the University of Wisconsin-Madison. His current clinical practice focuses primarily on geriatrics. He has written and contributed to many articles and is frequently invited to speak on psychiatric topics, such as psychiatry and the law, depression, anxiety, dementia, and suicide risk and prevention.

In the treatment of sleep problems, it is always best to first try non-pharmacologic options so there is no danger of side effects. The first step is to adopt standard sleep hygiene techniques that have been shown to be effective. These include, first, maintaining a regular sleep wake cycle, so that the time one goes to sleep and wakes up vary by only an hour from night to night. This prevents disruption of circadian rhythms, the changes in our endocrine systems during the day, and improves sleep. Next, one should exercise regularly, but not within several hours of going to sleep. One should avoid daytime naps, because they can interfere with sleep at night, and should avoid heavy meals within a couple of hours of going to bed. It is important to avoid stimulants, such as caffeine within at least 3 or 4 hours of going to sleep. Some people who are particularly sensitive may have to restrict caffeine to the early morning or decrease its use, sometimes even eliminate it. One should work to create a comfortable, quiet, dark and temperature controlled bedroom and develop a relaxing routine for the hour before getting into bed. In addition, it is best to use the bedroom only for sleep and sexual activity. It is also best to avoid alcohol within several hours of going to sleep. While alcohol can help with sleep onset, it often leads to early morning awakening and it disrupts the quality of sleep. Finally, it is best not to stay in bed if you are having trouble sleeping beyond 20-30 minutes. At that point it is best to get up and attend to a quiet activity such as reading a book or watching television. Once you become tired and feel sleep coming on, it is time to get back in bed.

If none of these techniques seem to help, it is a good idea to discuss the sleep problem with your physician. There are a number of medical problems that can disrupt sleep such as pain, sleep apnea disorder, restless leg syndrome and endocrine illnesses. There are also medications for particular medical problems that can cause insomnia. Depression and anxiety can also disrupt sleep. If your physician does not believe you are struggling with these illnesses or medication side effects, then one may want to consider working with a talk therapist to learn relaxation skills or other strategies to help relax while going to sleep. Finally, there are a number of medications that can be prescribed to help insomnia.

The first group of medications that can help with sleep are known as benzodiazepines. These include such medications as temazepam (Restoril), flurazepam (Dalmane), estazolam (Prosom), triazolam (Halcion), and quazepam (Doral). These are drugs which interact with the neurochemical GABA to cause sedation, memory loss, a decrease in anxiety, and they can be muscle relaxants and antiseizure drugs. These drugs vary in their onset and length of action. Temazepam, for example, is most effective when it is used to help with sleep onset, whereas flurazepam is most effective in helping someone stay asleep. These medications tend to lose their effectiveness over time and the associated effects such as memory problems and sedation can carry into the next day.

There are several non-benzodiazepines that can also be effective in the treatment of insomnia. These include zolpidem (Ambien), zaleplon (Sonata), eszopicione (Lunesta) and ramelteon (Rozerem). The first three drugs work primarily by binding to a particular subunit of GABA. Zaleplon has the fastest onset of action, but it is very short acting. Zolpidem also has a rapid onset of action, but not quite as quick as zaleplon, and it lasts a bit longer. Eszopicione also has a reasonably fast onset of action, but it lasts significantly longer than zolpidem or zaleplon. The advantage of a longer onset of action is that it will help avoid early awakening, however, it may mean its sedating effects will still be present the next morning. These medications do not have the same memory effects as the benzodiazepines and there is controversy about whether they lost their effectiveness over time. Ramelteon is a new medication that stimulates melatonin receptors. Melatonin is a substance in our body that helps modulate the circadian rhythm, the endocrine changes in our body through the day. It plays a key role in the sleep wake cycle, and taking melatonin itself has been popular to help with sleep. Unfortunately, taking melatonin itself does not seem to help with sleep, perhaps because it is metabolized quickly. Ramelteon has a fairly rapid onset of action, and it lasts for an intermediate amount of time in comparison to the other medications discussed. There are a number of over the counter medications for sleep such as the antihistamine Benadryl, but they either do not work effectively or interfere with the quality of sleep. If you do choose to try an over the counter product, it is important to inform your physician. These medications can interact with other medications so if you are going to be taking them regularly, the dosages of other medications may need to be adjusted.

Community Answers

Marc boyd answered...

Melatonin has worked well for me for years. I am 65 and do not want to take any more drugs.

Katherine martin answered...

Yes, melatonin works for me as long as its a small dose= 1 mg

A fellow caregiver answered...

My problem is not falling asleep it is staying asleep I woke up every two hours to take care of my mother for nine years and now I only sleep for one and a half to two hours and I'm up for a few hours then I go back to sleep this happen through out the night please help

A fellow caregiver answered...

Staying asleep will involve keeping a regular schedule to go to sleep, turning off all distractions, eating right and exercise. It means staying away from caffeine and sweets several hours before bedtime and not go to bed hungry or on a full stomach. Having taken care of someone with one eye open for several years, if you can get someone you can trust and is reliable to take turns with you watching your relative could help If all that fails, talk to a licensed therapist and your doctor about what options you should be looking at. Great luck to you!

Ye olde rn answered...

I've been an RN for 35 yrs. & understand what you're saying. I've included the same detailed info I give all my sleep-deprived patients. But first, may I offer my condolences on losing your mother. Regardless of how long they were ill, be it 90 minutes or 9 years, it still is a shock when someone close passes. Often there's a greater feeling of loss when that person has been our constant companion, even if in illness, for a long time, whether you realize it or not or think (or know) their passing was 'for the best'.

Second, it's going to take time to get over that 2-hr. limit you spent 9 years perfecting. I had much the same problem when I switched from straight night shift (15 yrs.) to took about 3 months before I was able not only to fall asleep at 10 p.m. (my usual waking time) but to stay awake on day shift without vast amounts of caffeine. Expect it to take several months before your 'clock' resets to let you sleep through the night without some form of help.

Put a (cheap) microwave in your bedroom, preferably close to your bed to avoid having to go to the kitchen or move around too much when you wake to avoid waking you physically as well as mentally. (read on for why). [FYI: I put the smallest one I could find ($29) on my nightstand]

Decide on a time you'll go to bed every night & try hard not to break it. Even if you can't fall asleep at first, keep to the schedule. (Read above for that) Don't take Melatonin yet.

When you wake up the first time, have some plain white milk (any percent of fat) in a glass or glass bottle (like Snapple comes in) nearby, if at all possible rather than in the kitchen fridge. Keep it cool by placing it in a bowl of ice or a mini-fridge next to the bed.

Heat the milk (about 30 sec) to where it's quite warm but drinkable. Warm milk really does help insomnia due to a change in the milk proteins when they're heated. Drink at least 6 0z.(Lactaid free is fine if you can't tolerate regular milk).

Take a Melatonin tab at this time & lay back down. If you don't fall asleep in 20-30 min. this time, have a nice, not too-interesting book at hand (at this point, try to avoid getting out of bed). Try to keep the light as low as possible...just enough to illumine the book but not the whole room. (a small goose-neck lamp with a 40-watt bulb usually is perfect) Read for about 20 min & try to go back to sleep.

If that doesn't work or you want a pill-free cure, try one of these; 1) Put a 'white-noise' machine near the head of your bed. (it can be on the floor). These block other noises & outside distractions & when you focus on listening to the sound it sets a soothing slow rhythm that causes the brain to 'let go' of whatever negatives are keeping you awake. Get the type that runs all night, rather than for 30min or an hour because you don't want to wake up when it shuts off. Even asleep your brain hears the sound & it may override your impulse to wake up. Google 'white noise machines for a selection. Conair makes an excellent less-expensive model with multiple sounds to choose from (I like the 'night train' on mine, followed by the 'waves on the beach'). [Mine runs on AC which is important if you're going to run it all night.]

You can also try this simple auto-relaxation exercise with or without the machine. (I learned it from a sleep therapist after a month of tossing & turning & nothing seemed to work. Now I use it for patients with insomnia.) 1. Lay quietly in bed in the dark. Get comfortable. If you can't lie on your back, any position will do. 2) Start by relaxing all the muscles in your feet & ankles. If you're not sure how they should feel try tensing the muscles briefly & then relaxing. THAT's what you're trying to accomplish.

3) Concentrate on just them until they feel loose. 4) Now work on your lower legs (below the knee). Concentrate on relaxing every muscle in them (don't let your feet tense up while you work on your lower legs. If you feel them tensing, get them re-relaxed then continue on your legs. 5) Try to imagine you're floating off the bed, feet & all.

Work your way 'up' from there. Next are your upper legs, then your pelvis, then the abdomen, lower back, hands, forearms, upper arms, shoulders, upper back, neck & finally your face & head. ( Actually, I've never seen anyone who tried this ever get past their abdomen... but you never know...)

This works by taking your focus off anything distracting (like that 2 hr 'alarm' you used to have) & making your mind work on just 1 thing...relaxing. Try to keep stray 'tight' thoughts out. (Mom, bills, work, Mom's-not-in-the-next-room, the broken what-ever, Mom again, etc.) It may take some practice, but you'll be amazed at how well this works with even the most insomniac patient. Don't give up if you think it's not working. It will if you don't force it. The whole idea is to s-l-ow-l-y relax so you can fall asleep, or back to sleep. Best of all, since there are no pills or drugs at all you can repeat this as often as needed every night.

Once you get the technique learned it takes less & less time to fall asleep until you're out before you get past your feet. It's the safest & surest method I've ever seen & has zero side effects.

If you have any underlying health problems ask your doctor before trying ANY of the over-the-counter sleep aides because ALL of them (except Melatonin, which is a natural hormone) have diphenhydramine (Benadryl) as their main 'wonder' drug to make you sleepy. No says so right on the Benadryl box :'causes drowsiness'. That's why when you're admitted to the hospital most doctors order a Benadryl first. They only order the other meds (especially for seniors) if they have a diagnosis which precludes the use of diphenhydramine...which is why I strongly recommend you check with your doctor before using them.

Good luck & great sleep :)