Doctor on Call: Risks and tips for sleep medicine use in seniors

As people age, their sleep patterns naturally change, sometimes making it difficult to maintain a normal sleep schedule. Geriatrician Dr. Shandini Sharma explains why some seniors might consider sleep medication and why caution is essential.

Dr. Sharma says a common sleep pattern change called a “frame shift” happens with aging:

"Instead of sleeping at 10 and getting up at 6 in the morning, some elderly sleep at 7 p.m., so they wake up at 4 a.m. Or some elderly start sleeping later."

She emphasizes that this change is normal but can be challenging if seniors wake early and can’t fall back asleep. Instead of immediately turning to medication, Dr. Sharma suggests considering sleep hygiene strategies:

"Would you like to dope yourself to sleep again? Or would you like to just get up and do something instead if you physically can? Or engage in something that will make you active and spend that extra energy so that instead of sleeping at 7 p.m., you'd sleep again at 9 p.m.?"

Melatonin is the only safe sleep medicine she recommends for seniors, but she cautions patience:

"People take melatonin and they want to feel like, oh my God, now I'm going to be doped out to sleep immediately. No, it doesn’t. It takes a while to work. Give that time. Your sleep didn’t get abnormal in a hurry. It won’t get back to normal in a hurry."

Dr. Sharma issues a strong warning against over-the-counter nighttime pain relievers combined with sleep aids such as Tylenol PM or Advil PM:

"Never take Tylenol PM or Advil PM. Never. It will make you fall. It will make you go into the streets naked."

Falls are a serious risk for frail seniors taking sleep medicines:

"Senior, frail. They’re already frail. Who are already frail. They take a sleep medicine, they’ll fall. They’ll fall, not only fall, they’ll fracture. In a moment, life has changed."

If sleep medicine is necessary, Dr. Sharma advises using the lowest effective dose:

"If you at all need to take sleep medicine when you’re a senior, take the least effective dose."