Sedatives and sleep aids, suitable for older demographics?

[JohnBoy2000]

Just personal interest from the point of view of increasing side effects at more advanced ages.

When I was younger (20's and early 30's), I could take any and everything with almost no real side effects. Moving into mid to late 30's, side became much more pronounced. It may have been relative to a slow down in my diet and exercise regiment, but I have to attribute some of it to advancing age as well.

My Dr mentioned as folks get older, caffeine sensitivity almost reliably becomes more pronounced.

Specifically anti-cholinergic sides in the elderly population is the one that's concerning due to delirium and increased accident probability.

GABA's like benzo's and Z-drugs are a big no-no due to impact on memory function?

There's a new class acting on orexin targets, not something I'm very well familiar with, but have been brought to market in recent years. I remember Eric Nestler wrote about this as being a research drug many years ago.

Daridorexant/Quviviq being the primary current option.

Then older options like:

- Trazadone, don't think this has cholinergic sides but can cause drowsiness.

- Mirtazapine, tried and true but unsure how suitable it is in the elderly given effect on glycine.

- Doxepin, old tricyclic but used at super low does apparent mitigates potential cholinergic sides.

- Amitriptyline, same as doxepin but more frequently used, more cholingeric sides at insomnia doses?

Thoughts?

I used to hyper dose promethazine in my 30's and got great sedation and pleasant delirium, but I would be very cautious about doing that now or again in the future.

 

[Nautica24]

- Clonidine - If no bp issues then is good for sleep, relaxation
- Cannabis - Low dose THC/CBD Gummy even dosage mg/mg in the gummy

 

[JohnBoy2000]

Clonidine

Interesting.

Older adults are more vulnerable to side effects, including:

• Orthostatic hypotension, dizziness, and increased fall risk.
• Excessive sedation, daytime drowsiness, or confusion.
• Effects on heart rate/blood pressure (especially if already on antihypertensives).
• Potential to disrupt sleep architecture (e.g., REM suppression) or, paradoxically in some cases, contribute to insomnia/nightmares when used for blood pressure.

Not first line, but still interesting.

Though not without risks.

Cannabis - Low dose THC/CBD Gummy even dosage mg/mg in the gummy

I know historical CBD has such a reputation, unsure in practice how effective it is though.

Never tried CBD but MJ never did anything to improve sleep for me personally.

• CBD isolate alone often shows little or no significant advantage over placebo for primary insomnia outcomes in controlled trials (e.g., 150 mg nightly CBD was similar to placebo on most sleep measures, with possible wellbeing benefits).
• Effects appear stronger or more consistent with non-CBD cannabinoids, multi-cannabinoid formulations, or combinations with terpenes. One RCT of 300 mg CBD + specific terpenes found a small increase in slow-wave + REM sleep percentage (more pronounced in some subgroups).

Orexin seems to be thought of as the new side-effect free sleep-aid therapeutic target.