Are Sleep Medications Bad for Your Brain?

• Sleeping pills may raise your risk of permanent memory loss
• Cognitive behavior therapy is more effective than medications for resolving sleep problems
• The quality of your sleep may be more important than the number of hours you sleep
• Recommendations from the Global Council on Brain Health can help improve sleep quality

Bad sleep is like bad sex: It’s not the best use of your mattress. And for many Americans, a lack of solid slumber is keeping them, well, up at night. More than half of Americans 40 and older say they struggle to sleep through the night, and only 41 percent say their sleep is excellent or very good, AARP’s 2016 Sleep and Brain Health Survey found. 

With so many people seeking quality zzz’s, sleeping pills can seem like an easy fix. Nearly a third of people age 40-plus take prescription sleep medications, according to the AARP survey, and 33 percent take over-the-counter meds. Many take both types. But this quest for a simple solution carries risks: Half of those who use over-the-counter sleep aids make dangerous dosage mistakes, from taking the pills for too long to combining them with other medications and supplements, a 2016 Consumer Reports survey found. Unfortunately, long-term use of many of these medications is linked to an increased risk of dementia, and in many cases they do not provide people with the restful sleep they seek.

“There’s little data to suggest that over-the-counter sleep aids are even effective,” says Sonia Ancoli-Israel, emeritus professor in the school of psychiatry at the University of California, San Diego, School of Medicine. These anticholinergic meds, which range from sleep aids to antihistamines such as diphenhydramine — found in Benadryl, Tylenol PM, Advil PM and many cold and allergy medications — can affect short-term memory. High doses and long-term use significantly increase your risk of developing dementia, found a study from the University of Washington and Group Health Cooperative, a nonprofit health system based in Seattle. Taking the meds for 60 days or more caused memory problems in older adults, according to a May 2013 study in Alzheimer’s & Dementia.

“More and more, we think that sleep quality — not the amount of sleep — is what’s important” for brain health, says Kristine Yaffe, M.D., chief of neuropsychiatry at the San Francisco VA Medical Center and a professor at the University of California, San Francisco. Scientists suspect that the brain flushes out toxins during sleep, as researchers at the University of Rochester Medical Center discovered in a study involving mice. These toxins could include beta-amyloid, a protein associated with Alzheimer’s disease, and if you’re not sleeping well, Yaffe says, you’re not clearing out the proteins.

Scientists don’t yet know if prescription medications provide the high-quality sleep you need to remove those toxins, though these sedative-hypnotics, as the drugs are called — which include benzodiazepines such as Xanax and Doral, and nonbenzodiazepines such as Ambien — allow you to experience all stages of sleep, Ancoli-Israel says.

The problem, however, is side effects. Benzodiazepines increased Alzheimer’s risks in participants who used them for three months or more, a September 2014 study in the British Medical Journal found. A February 2016 study came to a different conclusion — researchers at the University of Washington and Group Health in Seattle found no rise in dementia risk for adults 65 and older who used the drugs — but the study authors still warned health care providers to avoid prescribing them to older adults. Nonbenzodiazepines present some of the same dementia risks, Ancoli-Israel says.

So how can you improve your sleep without relying on pills? Here are some good strategies:

Focus on strong sleep hygiene

Good sleep is vital to brain health and cognitive function. That’s the main takeaway from a 2016 report issued by the Global Council on Brain Health (GCBH), an independent group of scientists, health professionals, scholars and policy experts. Sleep issues often increase with age, the report notes — from waking up more frequently to not sleeping as deeply — but behavioral changes can frequently solve the problems. The council’s recommendations include:

• Go to bed only when you feel drowsy, and don’t stay in bed if you feel awake
• Exercise — physical activity promotes good sleep
• Avoid caffeine after lunch and alcohol several hours before bedtime
• Limit your eating and drinking three hours before going to bed
• Talk with your doctor about sleep issues

Consider cognitive behavioral therapy (CBT). “It’s the most effective treatment for insomnia in older or younger adults,” Ancoli-Israel says. With CBT, patients keep a sleep diary, then work with a sleep therapist to improve their habits (the National Sleep Foundation offers a directory). In an August 2015 study in the Annals of Internal Medicine, people who underwent CBT for insomnia fell asleep about 20 minutes faster — and were awake nearly 30 fewer minutes at night — than those who didn’t undergo therapy. That’s comparable to, or better than, results for drugs such as Ambien and Lunesta, writes Julie Corliss, executive editor of the Harvard Health Letter.

“CBT changes negative behaviors,” Ancoli-Israel says. “It’s like teaching a person how to sleep.”