Best Sleep Aids for Seniors: What Really Works?

Even if you breezed through most of your life with no sleep issues, you may find getting a good night's sleep becomes more challenging as you get older. There are often multiple issues that sabotage sleep quality as you age, according to Dung Trinh, M.D., an internist at MemorialCare Medical Group and chief medical officer of Healthy Brain Clinic in Irvine, CA.

"Older adults often spend less time in deep sleep, wake more frequently during the night, and may become sleepy earlier in the evening and wake earlier in the morning," he says. "However, ongoing insomnia or severe daytime fatigue should not simply be written off as a normal part of aging."

Confounding factors can include conditions like arthritis, heart or lung disease, dementia, and chronic pain, which are all more common in older adults than those who are younger, he adds. In addition to one or more of these, you may also struggle with acid reflux, restless legs syndrome, sleep apnea, depression, or anxiety.

"Added to that, medications can also play a part, especially when a person takes several prescriptions," says Dr. Trinh. "Lifestyle factors are another layer of issues that can disrupt the sleep-wake cycle." Those include drinking too much caffeine, being sedentary, taking long or late naps, limiting daylight exposure, and consuming alcohol.

Identifying what's causing the sleep problem is the most important first step. Next step? Figuring out the best options for easing sleep difficulties as you're working to address the root cause.

How to Choose the Best Sleep Aid for Your Needs

Medications and supplements can play a role in helping with sleep issues but should be utilized on a short-term basis in specific situations—for example, getting over jet lag or minimizing the effects of a few nights of insomnia. Dr. Trinh says they're rarely the best long-term solution for sleep issues.

Instead, for ongoing sleep challenges one of the most effective approaches is cognitive behavioral therapy for insomnia (CBT-I). Considered a first-line treatment, this short-term structured therapy is done with a licensed therapist and involves examining your sleep routine and habits and making meaningful changes.

These adjustments may include moving back your bedtime or implementing a specific time each night to go to bed, as well as strategies related to emotional health such as looking at causes of anxiety that might be keeping your mind spinning instead of snoozing.

"CBT-I is often utilized to help address thoughts and behavioral patterns that could be contributing to sleep loss," says Yulgeim Gomez, L.M.H.C., a therapist and specialist in cognitive behavioral therapy at Pathways Psychological Services in New York City. "It's particularly helpful if stress or anxiety are the primary reason for difficulty sleeping." Typically, each CBT-I session lasts between 30 to 60 minutes and is done weekly for up to eight weeks, depending on what you need addressed, says Gomez.

"This type of therapy is especially valuable for older adults because it avoids many of the side effects associated with sleep medications," adds Dr. Trinh. "Another major advantage is that the benefits can continue after therapy ends, because the person has learned new sleep behaviors, rather than depending on a medication every night."

Do Natural Sleep Aids for Seniors Work?

If you do explore using a sleep aid, many people gravitate toward options that are marketed as "natural" because they contain herbs, minerals, or a hormone like melatonin—which is naturally produced in the body.

"Natural sleep aids may be helpful, but they should not automatically be considered safer or more effective simply because they're sold as supplements," says Dr. Trinh. "Herbal products are often marketed as gentle or natural, but the evidence supporting them is generally much weaker than the evidence for behavioral treatment such as CBT-I." Also, people may have allergies to specific plants like chamomile or lavender, he adds.

The larger concern comes with potential interactions with prescription medications, says Dr. Trinh. Research has found that St. John's wort can change how certain drugs work, including statins and blood thinners, he notes, and kava supplements may affect how your body processes antidepressants. "A doctor or pharmacist should ideally review all supplements, along with prescription and over-the-counter medication," Dr. Trinh adds.

Let's take a look at some of the more common choices.

Chamomile

Chamomile tea may feel soothing, but evidence that it treats insomnia is weak. Some small studies have reported modest improvements in sleep quality, while one review found no meaningful benefit for insomnia. Chamomile is generally safe in tea amounts but can cause reactions in people allergic to ragweed or related plants.

GABA

GABA is a neurotransmitter that reduces activity in the central nervous system, but it is unclear how much supplemental GABA reaches the brain. A systematic review in Frontiers in Neuroscience found limited evidence that oral GABA improves sleep, although a few small trials suggest it may shorten the time required to fall asleep. Larger, independent studies are needed.

Hops

Hops are commonly combined with valerian in sleep supplements, but evidence for hops alone is unconvincing. In a systematic review, two placebo-controlled trials found no significant improvement in sleep quality; studies of valerian-hops combinations have produced somewhat more promising but still limited results.

Kava

Although kava is promoted for its calming and sedating effects, very little research supports its use for insomnia. More importantly, kava products have been linked to rare but serious—and sometimes fatal—liver injury and should not be combined with alcohol or sedative medications.

Lavender

Some studies suggest lavender aromatherapy may modestly improve perceived sleep quality, particularly when poor sleep is related to anxiety, but the overall evidence remains uncertain. A review of 16 studies found encouraging results for aromatherapy, but larger and more rigorous trials are needed to substantiate the findings. Lavender oil may cause headaches, coughing or skin irritation and should not be swallowed unless it is a product specifically formulated for oral use.

St. John's Wort

St. John's wort has evidence supporting its use for mild to moderate depression, but not as a treatment for insomnia; trouble sleeping is actually one of its possible side effects. It also interacts with many medications—including antidepressants, blood thinners, statins, seizure drugs and some heart medications—so it should not be used without consulting a healthcare professional.

Valerian Root

Research on valerian is inconsistent: some studies report modest improvements in sleep quality, while others find no advantage over placebo. The American Academy of Sleep Medicine recommends against using it for chronic insomnia because the evidence is insufficient. Valerian appears reasonably safe for short-term use but may cause dizziness or mental dullness and should not be mixed with alcohol or sedatives.

Is Melatonin Safe for Seniors?

One commonly used supplement is melatonin, but even though this is a naturally occurring hormone in the body, it's best taken on a short-term basis, says Dr. Trinh.

"Melatonin is a hormone involved in regulating the body's internal sleep-wake clock, so it may be particularly helpful when the problem involves circadian timing, such as difficulty falling asleep at an appropriate hour, jet lag, or certain sleep-wake rhythm disorders," he says. "It is less clearly effective as a general treatment for every type of chronic insomnia."

Also, although it's generally well tolerated, melatonin may come with some side effects, according to research on the supplements. These can include daytime sedation, irritability, restlessness, abnormal dreams, anxiety, nausea, and diarrhea. There may also be increased fracture risk, so care should be taken for older adults who are dealing with osteopenia or osteoporosis.

Are Over-the-Counter Sleep Aids Safe for Older Adults?

In addition to natural remedies, numerous over-the-counter sleep aids are marketed as a way to help you fall asleep and stay asleep. These usually involve a sedating antihistamine such as doxylamine (Unisom) or diphenhydramine (ZzzQuil). While they can be effective in the short-term, they are not always ideal for seniors.

"These drugs can make someone sleepy, but they can also produce next-day grogginess, confusion, blurred vision, constipation, dry mouth, difficulty urinating, memory problems, and an increased risk of falls," says Dr. Trinh. "Older adults are particularly sensitive to these effects because the body may process medications more slowly and the brain may be more vulnerable to side effects."

Combination products are another concern, he adds. For example, a nighttime pain product may contain both a sedating antihistamine and acetaminophen—as with Tylenol PM—meaning a person could unintentionally take additional medication they do not need or double-dose ingredients contained in other products, says Dr. Trinh.

"These medications should generally not become a nightly habit," he suggests. "If someone finds that they repeatedly need an OTC sleep aid, that is a good reason to speak with a healthcare professional and investigate the underlying sleep problem."

Prescription Sleep Medications for Seniors

Prescription sleep medications may be considered when insomnia is persistent, significantly affects daytime function or quality of life, and does not improve sufficiently after underlying causes and behavioral approaches have been addressed, according to Dr. Trinh.

"The choice depends on the individual's primary difficulty, whether they struggle to fall asleep, stay asleep, or wake much too early, as well as their other medical conditions and medications," he says. Options may include medications such as ramelteon, which acts on melatonin receptors, very low-dose doxepin for sleep-maintenance problems, or newer orexin-receptor antagonists that target wake-promoting pathways in the brain.

"Other sedative medications may occasionally be used, but clinicians tend to be particularly cautious with benzodiazepines and drugs such as zolpidem in older adults because of risks including falls, confusion, memory impairment, next-day sedation, and dependence," he says. "In geriatric care, the goal is generally to use medication only when there is a clear reason, start with the lowest appropriate dose, avoid unnecessary combinations, and reassess regularly to determine whether the drug is still needed."

What Helps Seniors Sleep Through the Night?

Whether you're utilizing CBT-I or taking supplements (or both), lifestyle habits can also make a difference when it comes to getting better sleep. Some that can be helpful include:

• Getting sunlight as soon as possible in the morning, since this helps "reset" your body clock and that can subsequently make bedtime easier.
• Limiting late naps, caffeine, and alcohol because all of these may make it more difficult to fall asleep at night.
• Staying active during the day to promote natural tiredness at night.
• Reducing fluids in the evening if appropriate to minimize bathroom trips overnight.
• Choose an adjustable bed that can help position the body at a more comfortable incline.

One of the most essential lifestyle habits is maintaining a consistent bedtime and wake time, even on the weekends and during vacations, says Gomez.

When to Talk With Your Doctor

If you've implemented numerous lifestyle changes and are still experiencing sleep problems—particularly if those difficulties are affecting your ability to function during the day—it's worth having a conversation with your doctor, suggests Gomez.

"It's also important to seek medical advice if you're using sleep medications or over-the-counter sleep aids regularly, because the medication itself may eventually become part of the problem," adds Dr. Trinh. He says other issues to notice that may be related to sleep challenges are:

• New or worsening confusion or brain fog
• Frequent falls, difficulty balancing, or experiencing mobility concerns
• Worsening depression or mood changes
• Unusual nighttime behaviors, such as having to urinate much more often than usual

"Keeping a sleep diary for one or two weeks that includes information like bedtime, wake time, naps, caffeine consumption, physical activity, medications, and nighttime awakenings can be useful," Dr. Trinh suggests. "This can help you and your clinician spot any patterns and identify potential causes that can be adjusted to allow you to get better sleep."

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