WHAT ARE SEDATIVE-HYPONTIC USE MEDICATIONS ?
Nearly one-third of older people in Canada take sleeping pills. These medications are called sedative-hypnotics. Benzodiazepine receptor agonists, also known as BZRAs, are among the most commonly prescribed sedative-hypnotics in Canada, particularly for older adults. BZRAs work by slowing down activity in your brain and spinal cord.
Health care providers prescribe BZRAs and other similar sedative hypnotics for sleep problems. They may also be prescribed for other conditions, such as anxiety, seizure disorders or alcohol withdrawal. Although these medications sometimes offer small benefits for insomnia and anxiety in the short term, they stop working and become harder to wean from over time. Despite this, the serious side effects of taking them remain. Usually older adults should try non-drug treatments first. There are often safer and better ways to improve sleep or reduce anxiety.
There are a number of BZRAs and other sedative-hypnotics that may have risks for older adults and these should be flagged and reviewed when used long-term. If you are not sure, ask your pharmacist or primary care provider.
TYPES OF SEDATIVE-HYPNOTIC MEDICATIONS
Alprazolam (Xanax)
Amitryptline (Elavil)
Bromazepam (Lectopam)
Chlordiazepoxide (Librax)
Clonazepam (Rivoltril)
Clorazepate (Tranxene)
Diazepam (Valium)
Eszopiclone (Lunesta)
Flurazepam (Dalmane)
Lorazepam (Ativan)
Nitrazepam (Mogadon)
Oxazepam (Serax)
Temazepam (Restoril)
Triazolam (Halcion)
Zaleplon (Starnoc)
Zolpidem (Sublinox/
Ambien)
Zopiclone (Imovane)
WHAT ARE THE RISKS OF SEDATIVE-HYPNOTICS?
Sedative-hypnotic medications can cause many side-effects, especially dependence after long-term use. Except in special cases, these medications should never be taken long-term. If you are prescribed BZRAs, in general they should not be taken for longer than four weeks in a row. BZRAs can help with reducing anxiety and sleep problems for a few days or weeks, however, long-term use can have dangerous effects on one’s health and well-being. It worsens your brain function and slows down your reflexes. All sedative-hypnotics have specific added risks for older adults. They are likely to be more sensitive to the medication’s effects than younger adults. In addition, these medications can stay in their bodies longer.
For older adults, the use of benzodiazepines can cause:
- Drowsiness
- Daytime fatigue
- Falls
- Fractures
- Confusion
- Memory and concentration problems
- Hospital visits
- Car accidents
The potential risks of taking benzodiazepines usually outweigh their potential benefits. If you are taking a sedative-hypnotic, you should not take them with:
- Cannabis
- Alcohol
- Opioids
- Other sedative-hypnotics
As you age, many changes take place in your body including how your body processes medications. Medication will remain in your body for longer periods of time. As you get older, this means it could be making you feel tired and weak. It could also impair your balance, slow your thinking and reduce your other senses. Talk to your primary care provider, mental health clinician or pharmacist to discuss this further as other treatments can also relieve your anxiety or improve your sleep.
ALTERNATIVES TO SEDATIVE-HYPNOTICS
To alleviate anxiety and improve sleep, there are a variety of treatments that are proven to be more effective and safer than BZRA use. Keep in mind that anxiety and sleep problems can sometimes be caused by depression. Talk to your primary care provider or mental health clinician to help you determine if you have depression and the best treatment plan for it.
Ways to improve sleep:
- Try to go to bed at night and wake up in the morning at the same time everyday
- Read or watch TV in a chair or couch instead of in your bed
- Do deep breathing or relaxation exercise before bed
- Do not use any substances before bed that may keep you awake such as alcohol, caffeine or nicotine
- Read our pamphlet ‘Managing Sleep in Older Adults’ that includes additional tips and resources
Ways to improve anxiety:
- Talk to someone such as a counselor, therapist, mental health clinician or family member about your feelings
- Try relaxation techniques such as stretching, yoga, deep breathing and meditation to help relieve stress
- Read our pamphlet ‘Recognizing and Managing Anxiety’ that includes additional tips and resources
It’s important to ask your primary care provider for more information on these and other ways to help anxiety and sleep problems without using medication.
HOW TO SAFELY REDUCE AND MANAGE SEDATIVE-HYPNOTIC USE
If you are an older adult currently taking BZRAs or another type of sedative-hypnotic, speak to your primary care provider, mental health clinician or pharmacist about whether stopping your sedative-hypnotic is the right choice for you.
Stopping sedative-hypnotic medications suddenly can cause unpleasant withdrawal effects. To avoid this, your care providercan discuss and design a plan with you to reduce your dose very slowly. Once you start to reduce your dose, you may be able to think about stopping them altogether. Your care providers can also help put in place non-drug therapies to help you sleep better and reduce your anxiety, which have been proven to be safe and effective.
Withdrawal symptoms can appear even after a few weeks of daily use, as well as for individuals using BZRAs for a longer period of time. Withdrawal symptoms may occur but are usually mild and short term (from a days to a few weeks).
Withdrawal symptoms can include:
- Anxiety
- Irritability
- Insomnia
- Sweating
- Nausea/vomiting
- Diarrhea
Benefits of Sedative-Hypnotic Tapering:
- Lowers the risk of falls
- Increased alertness and energy
- May improve thinking ability and memory
To avoid unpleasant withdrawal symptoms, your dose should be reduced gradually. A tapering program used with assistance from your primary care provider or pharmacist can minimise and sometimes avoid these withdrawal effects.
TREATMENT OPTIONS
If you are currently taking benzodiazepines and would like to stop taking them, your primary care provider or mental health clinician along with your pharmacist can help create a plan to slowly reduce or taper your dose. Stopping these medications suddenly can cause unpleasant or even dangerous withdrawal effects.
Your primary care provider or mental health clinician can also help you with finding alternatives to reducing your anxiety and improving your sleep.
At your next appointment:
- Write a list of questions you’d like to ask so you can cover everything you need to at your appointment.
- Bring a family member or friend with you to provide support.
- If you are taking a sedative-hypnotic, ask for more information about the risks and benefits. Asking questions about the uses of sedative-hypnotics, their risks and benefits, will help you make better decisions about your health.
- Request a full review of your medications every year by your primary care provider or pharmacist, these reviews can help you find potential problems with your medications and spot what should be changed or stopped.
EXAMPLE OF A SEDATIVE-HYPNOTIC TAPERING PROGRAM
SUGGESTED RESOURCES
CANADIAN MENTAL HEALTH ASSOCIATION
The Canadian Mental Health Association provides mental health and substance use and addiction services across Canada. Services include: group therapy, inpatient treatment, 12 step support groups and community treatment.
CANADIAN COALITION ON SENIORS MENTAL HEALTH
Provides resources and tools on substance use, addiction and mental health.
CANADIAN CENTRE ON SUBSTANCE USE AND ADDICTION (CCSA)
Provides resources on addiction, substance use and prescription drugs, as well as information on treatment options.
CONNEX ONTARIO
ConnexOntario provides free and confidential health services information for people experiencing problems with alcohol and drugs, mental illness and/or gambling. The information and referral services are available 24 hours a day.
COMMUNITY OUTREACH PROGRAM IN ADDICTIONS (COPA)
The COPA program helps adults 55 years and over who struggle with addictions that impact their daily lives. Services include: outreach-based treatment, seeing clients in their homes, harm reduction, motivational interviewing/counselling and solution focused therapy.
CENTRE FOR ADDICTIONS AND MENTAL HEALTH (CAMH)
The Centre for Addictions and Mental Health offers addictions counselling services, and is a source of information about addictions, management strategies and further resources.
Modified: 2020-12
We would like to thank the following for their support of our Education Resources to Support Healthy Ageing Initiative
- Mon Sheong Foundation and the Ben and Hilda Katz Foundation have generously provided funding to support printing and translation of our Education Resources to Support Healthy Ageing.
- The Ministry for Seniors and Accessibility supported this initiative with funding through its Seniors Community Grant Program.