Ask the Geriatrician: Sedative-Hypnotic Drugs and Related Medications
Ask the Expert
Ariel R. Green, MD, MPH
Fellow, Division of Geriatric Medicine and Gerontology
Johns Hopkins University School of Medicine
Sei J. Lee, MD, MAS
Assistant Professor, University of California San Francisco
Senior Scholar, San Francisco Veterans Administration Quality Scholars Fellowship
Q: What are sedative-hypnotic drugs and why are they prescribed?
A: Sedatives and hypnotics are two classes of prescription drugs that are commonly called “tranquilizers,” “sleeping pills,” and “sedatives.” They affect your central nervous system – your brain and spinal cord – and have a relaxing, calming effect. They are often prescribed to older adults for problems including anxiety, agitation, difficulty sleeping, and delirium (an abrupt form of confusion).
Sedative-hypnotic drugs must be prescribed with care. If they are misused or taken at doses that are too high, they can lead to loss of consciousness, and even death.
Q: What are some commonly prescribed sedative-hypnotic drugs?
A: There are two main types of sedative-hypnotics -- barbiturates and benzodiazepines. In the U.S., common barbiturates include Seconal (also known as secobarbital) and Luminal (phenobarbital). They are used for patients who have trouble sleeping. Common benzodiazepines include Xanax (alprazolam), Librium (chlordiazepoxide), Valium (diazepam), and Ativan (lorazepam). They are often prescribed for patients with anxiety and agitation.
Q: Are there other drugs that are prescribed for insomnia, agitation, and delirium?
A: Yes. Three newer, “non-benzodiazepine” drugs – Ambien (zolpidem), Sonata (zaleplon), and Lunesta (eszopiclone) – are also prescribed for insomnia. They are sometimes called “the Z drugs.”
Q: Are these medications a good choice for older people with anxiety, delirium or insomnia?
A: Studies suggest caution. They find that benzodiazepines and other sedative-hypnotic medications -- including the “Z drugs” -- more than double risks of falls and hip fractures leading to hospitalizations and death among older adults. In addition, benzodiazepines have been linked to higher risks of cognitive (thinking and memory) problems, delirium , and motor vehicle accidents. Research suggests that the Z drugs are not a safer alternative for older adults.
Benzodiazepines and other sedative-hypnotics should be used sparingly by older patients, and only after alternatives have been tried and failed. The recently revised 2012 American Geriatrics Society Updated Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults – one of the leading sources of information about safe prescribing for older adults – suggests that older adults avoid benzodiazepines because of the substantial risks associated with them. The criteria also recommend that the Z drugs not be prescribed for long-term use because they may cause similar side effects and have limited value in improving sleep.
Q: Are there non-drug alternatives that will help older adults sleep?
A: There are a number of effective, non-drug approaches older adults can take to get better sleep including watching your diet, exercising and maintaining a healthy bedtime routing. Visit the Healthinaging.org, and go to http://www.healthinaging.org/aging-and-health-a-to-z/topic:sleep-problems/ for more information.
Q: Are there non-drug alternatives that may help prevent or soothe anxiety?
A: Yes, there are a number of alternatives. Getting regular exercise may help, as may meditating, or simply taking slow, deep breaths. If that doesn’t help, consider psychotherapy, or “talk therapy.” A type of psychotherapy called cognitive-behavioral therapy can be particularly helpful in treating anxiety disorders. For more information about these techniques, visit Healthinaging.org and go to http://www.healthinaging.org/aging-and-health-a-to-z/topic:anxiety.
Q: Are there non-drug alternatives that can help older adults avoid delirium or treat it if it occurs?
A: The best way to treat delirium is first to prevent it. Once a person does develop delirium, they must get immediate professional attention and treatment. For more information on delirium visit Healthinaging.org and go http://www.healthinaging.org/aging-and-health-a-to-z/topic:delirium.
Updated: February 2013
Posted: February 2013