After reviewing more than 15 years of evidence, the American College of Physicians in May issued new guidelines for the management of chronic insomnia, recommending a form of counseling known as cognitive behavioral therapy as the first-line treatment for all adults. Drugs should be considered only if the therapy is unsuccessful, and only for a short course after a thorough discussion of the benefits, harms and costs, the guidelines say.
“Drugs don’t provide a natural sleep, and the side effects are significant,” says Nitin Damle, an internist and president of the American College of Physicians. “It’s true in all age groups, but even more problematic for older adults.”
In addition to their addictive properties, many prescription sleep aids can cause fuzzy thinking and memory gaps in the short term—like being unaware of taking a drive, eating or making phone calls. As bodies age, drugs remain longer in the body due to changes such as diminished liver and kidney function, which can cause fatigue, weakness, impaired balance and a dimming of other senses, increasing the risk for falls and car accidents. Longer term, sleep drugs may contribute to more serious mental-function issues, they can be costly, and they may not be covered by insurance for more than a short period.
Among the most commonly prescribed drugs are sedative hypnotics, which slow activity in the brain to bring on sleep. They include drugs known as benzodiazapenes, sold under brand names like Halcion, and non-benzodiazapenes, such as Ambien, Lunesta and Sonata. The American Geriatrics Society recommends against using benzodiazepines or other sedative hypnotics in older adults as first choice for insomnia because large-scale studies consistently show that the risk or motor-vehicle accidents, falls and hip fractures leading to hospitalization and death can more than double in older adults taking the drugs.
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