Ask the Geriatrician: Sedative-Hypnotic Drugs and Related Medications

Sei Lee and Ariel Green

Sei J. Lee, MD, MAS
Professor, Medicine
University of California San Francisco School of Medicine

Ariel R. Green, MD, MPH, PhD
Assistant Professor of Medicine
Division of Geriatric Medicine and Gerontology
Johns Hopkins University 

 

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,” or “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 and difficulty sleeping.

Research has shown that sedative-hypnotic medication, even in small doses, is not a safe long-term treatment for anxiety or insomnia, especially for people 65 and older.

Q:   What are some commonly prescribed sedative-hypnotic drugs?

A:   There are two main types of sedative-hypnotics – benzodiazepines and Z-drugs. Common benzodiazepines include Xanax (alprazolam), Librium (chlordiazepoxide), Valium (diazepam), and Ativan (lorazepam). Common Z-drugs include Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon). They are often prescribed for patients with anxiety and difficulty sleeping.

Q:   Are these medications a good choice for older people with anxiety or insomnia?

A:   Studies suggest they are not. They find that people who take benzodiazepines and Z-drugs are five times more likely to have memory problems, four times more likely to feel drowsy during the day, two times more likely to experience falls and fractures (such as hip fractures), and two times more likely to have a motor vehicle crash. These side effects can lead to hospitalizations and death among older adults. Research suggests that Z-drugs are not a safer alternative for older adults.

Medicines stay in the body longer with aging and are more likely to cause harmful side effects. Benzodiazepines and Z-drugs are also highly addictive. The body becomes used to them over time, which causes them to stop working.

For these reasons, benzodiazepines and Z-drugs should be avoided by older patients, except in rare cases. The AGS Updated Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults is one of the leading sources of information about safe prescribing for older adults. The Criteria suggests that older adults avoid benzodiazepines because of the substantial risks associated with them. The Criteria also recommend that the Z drugs should 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 people can take to get better sleep, including avoiding caffeine, exercising, and maintaining a healthy bedtime routine. (See the Caregiver Guide on Sleep Problems for more information.) 

Q:   Are there non-drug alternatives that may help prevent or treat anxiety?

A:   Yes, there are a number of alternatives. Getting regular exercise can be very helpful. A type of talk therapy called cognitive-behavioral therapy is also very good for treating anxiety disorders(For more information see the Anxiety topic.)

Q:   Can people safely stop benzodiazepines and Z-drugs on their own? 

A:   Please talk with your doctor, nurse, or pharmacist before stopping these medicines. It’s important to reduce the dose gradually because stopping these medicines suddenly can cause uncomfortable withdrawal effects.

Last Updated July 2019