Few prescriptions start with better intentions than a sleeping tablet. You have had weeks of broken nights, your GP writes a short script, and for the first time in a long while you sleep. The trouble is what happens next. These medicines were designed for a few weeks of use, yet Irish research shows most people over 50 who take them are still taking them well past that point.
TL;DR
- Benzodiazepines (nitrazepam, temazepam, diazepam) and Z-drugs (zopiclone, zolpidem) are licensed for short-term insomnia only. STOPP criteria flag benzodiazepines beyond four weeks and Z-drugs beyond two weeks as potentially inappropriate in older adults.
- Applying those criteria to TILDA data, researchers found roughly 56% of benzodiazepine users and 60% of Z-drug users aged 50+ in Ireland were taking them longer than recommended.
- Long-term use in over-65s is linked to an increase of more than 50% in the likelihood of falls, plus next-day drowsiness, memory fog and impaired driving.
- Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment, and its benefits outlast tablets.
- Never stop abruptly. Rebound insomnia and withdrawal are real, but a planned taper with your GP or pharmacist is very achievable.
- Over-the-counter sleep aids containing sedating antihistamines are not a gentler option after 50.
What we are actually talking about
Two families of medicine do most of the work. Benzodiazepines include nitrazepam (often sold as Mogadon), temazepam, diazepam and lorazepam. The Z-drugs include zopiclone (Zimovane) and zolpidem (Stilnoct). They act on the same receptor system in the brain and produce similar effects: faster sleep onset, fewer awakenings, and a sedative hangover that can linger into the following day.
Since May 2017 both groups have been controlled drugs in Ireland under the Misuse of Drugs Regulations, Schedule 4 Part 1. In February 2021 the HSE published dedicated guidance on prescribing them, aimed squarely at reducing long-term use and supporting people who want to come off them.
Why the timeline matters more than the dose
The clinical concern is rarely that the dose is too high. It is that the clock keeps running. Tolerance builds within weeks, so the tablet that gave you seven hours in January may give you four by June, at which point the original sleep problem has returned and a dependence has been added on top of it.
The STOPP criteria, developed at University College Cork and used across Europe to flag potentially inappropriate prescribing in older adults, put numbers on this. Benzodiazepines for four weeks or more, and Z-drugs for two weeks or more, both count as potentially inappropriate, on explicit grounds: chronic use increases the risk of falls and fractures.
The Irish picture is sobering
When researchers applied the latest STOPP criteria to The Irish Longitudinal Study on Ageing (TILDA), they found 31% of community-dwelling adults over 50 were taking at least one potentially inappropriate medication. Sleeping tablets featured heavily. About 56% of everyone in the study taking a benzodiazepine had been on it beyond four weeks, and close to 60% of Z-drug users were beyond two weeks. For most people over 50 in Ireland who take a sleeping tablet, long-term use is not the exception. It is the norm.
Why the risks change after 50
Liver metabolism and kidney clearance both decline with age, so the same tablet stays active longer and hits harder.
Falls and fractures. This is the big one. Long-term benzodiazepine use in people over 65 has been linked to an increase of more than 50% in the likelihood of falls. A sedative still circulating at three in the morning, plus a dark hallway and a trip to the bathroom, is a recognised recipe for a hip fracture. Our falls prevention guide covers the wider picture, but medication review is among the highest-value changes available.
Thinking and memory. Long-term use is associated with cognitive and psychomotor impairment, and this gets misread easily, by families and sometimes by patients themselves, as early dementia rather than a medication effect that could partly lift with a taper.
Driving. Under the Road Traffic Acts it is an offence to drive while under the influence of an intoxicant, and that includes prescribed sedatives. If you feel groggy in the morning, you are not safe behind the wheel, prescription or not.
What works better
Cognitive behavioural therapy for insomnia is the first-line treatment recommended by European and UK guidelines. It is not a relaxation class. It is a structured programme, usually four to eight sessions, tackling time in bed, conditioned wakefulness and the anxious arithmetic people do at four in the morning. Unlike tablets, the benefits persist after treatment ends. Ask your GP about referral to primary care psychology, and if you hold a medical card ask about Counselling in Primary Care, which offers free sessions. Aware runs free CBT-based Life Skills programmes, and there are reputable self-directed CBT-I workbooks and apps.
Two things are worth ruling out before anyone reaches for a script. Untreated obstructive sleep apnoea and restless legs syndrome both masquerade as insomnia and both get worse, not better, with sedatives. If you snore heavily, wake unrefreshed, or your partner has noticed you stop breathing, read our guide to sleep disorders after 50 and raise it with your GP. Alcohol matters too: it shortens sleep onset, then fragments the second half of the night comprehensively.
Melatonin and the pharmacy counter
Prolonged-release melatonin, marketed as Circadin, has a licensed indication unusually specific to this audience: short-term treatment of primary insomnia with poor sleep quality, in patients aged 55 or over. It is prescription-only in Ireland, 2mg before bed for up to thirteen weeks. The effect size is modest, but the safety profile compares very favourably to a benzodiazepine.
Sleep aids bought over the counter are a different story. Most contain a sedating antihistamine such as diphenhydramine or promethazine, and they are not a gentler option. They carry a meaningful anticholinergic load, meaning dry mouth, constipation, urinary retention and confusion, and tolerance develops within days.
If you are already taking them
Please do not stop suddenly. Abrupt withdrawal from benzodiazepines can cause serious symptoms, including seizures at higher doses. What works is a planned, gradual reduction, sometimes switching to a longer-acting equivalent first, stepped down over weeks or months at a pace you set. Expect the first week or two to be worse. Rebound insomnia is a genuine part of coming off, not evidence that you needed the tablet after all, and it passes. People who taper successfully often report clearer mornings and steadier balance afterwards.
- Book a dedicated review appointment rather than raising it as an afterthought at the end of a visit for something else.
- Bring every medicine you take, prescribed and over-the-counter, in a bag. Your pharmacist can flag interactions and duplicate sedatives.
- Keep a two-week sleep diary first, so you have a baseline rather than an impression.
- Agree the schedule in writing, including what happens if a step feels too steep. Slowing down is not failure.
- Start the CBT-I work before or alongside the taper, not after it.
Perspective helps: TILDA found adults over 50 in Ireland sleep an average of seven hours and forty-two minutes, with about 70% inside recommended ranges. Sleep does become lighter and more broken with age, and some of what feels like insomnia is normal ageing needing reassurance rather than a prescription. Our guide to how sleep changes as we age unpacks that distinction.
At Críonna Health we think the most useful thing you can bring to a GP is a good question, and this is a very good one: how long have I been on this, and what would coming off it look like?
This article is for general information and does not replace individual medical advice. Never change or stop a prescribed medicine without speaking to your GP or pharmacist first.
