Important: This page is for general information only. It cannot tell you whether you personally should take sleep tablets or exactly how to start or stop them. Never change, start, reduce or stop prescribed medicines – including sleeping pills bought online or “over the counter” – without speaking to your GP, pharmacist, specialist nurse or consultant. If you feel too drowsy to wake properly, have chest pain, very slow breathing, or a serious fall, seek urgent help via NHS 111 or 999.

What do we actually mean by “sleep tablets”?

People use the phrase “sleeping pills” for many different medicines. It can include:

• Benzodiazepine hypnotics (for example, temazepam) – older medicines that relax the brain and body.
• Z-drugs (for example, zopiclone, zolpidem) – similar in effect to benzodiazepines but chemically different.
• Melatonin – a hormone that helps time the sleep–wake cycle and is sometimes prescribed in later life.
• Sedating antidepressants or antipsychotics – sometimes used mainly for mood or other conditions, but which also cause drowsiness.
• Antihistamines and “night-time” cold remedies – available without prescription and often very sedating in older adults.

For older people, many of these medicines sit on lists of drugs that should be used with great caution because they can increase the risk of falls, confusion and memory problems. That does not mean they are “bad” or never useful – but it does mean decisions about them deserve time, questions and a clear plan.

Why decisions about sleep tablets are bigger in later life

In younger adults, a short course of sleep tablets may be used for a brief crisis. In older adults, the picture is more complicated because:

• Balance and reaction times are often slower, so any extra drowsiness raises the risk of falls and fractures.
• Memory and thinking may already be affected by age, stroke, dementia or medication; extra sedation can worsen this.
• Other medicines (for pain, bladder, mood, blood pressure, seizures and so on) may be acting on the brain and nervous system at the same time.
• Kidneys and liver may clear drugs more slowly, so tablets can build up in the body.
• Once started, some sleep tablets are hard to stop suddenly without withdrawal or “rebound” worse sleep.

Research has shown that older adults taking sedative–hypnotic medicines (including many sleeping pills) are more likely to fall and injure themselves than those who are not. Some long-term studies also link heavy use of these drugs with poorer thinking and memory in later life, although this may partly reflect the health problems that led to prescribing in the first place.

None of this means you must refuse sleep tablets if your team recommends them. It simply means your questions are reasonable and important – you are protecting your brain, your balance and your independence.

Before starting a sleep tablet: key questions to ask

If your GP, hospital doctor or psychiatrist suggests a sleep tablet, you might gently ask some or all of these:

1. “What problem are we treating – and have we checked the cause?”

Many things can disturb sleep in later life: pain, breathlessness, bladder or prostate symptoms, low mood, anxiety, leg cramps or jerks, sleep apnoea (breathing stopping and starting), disturbing dreams, carer stress, grief and more.

You could ask:

• “Do you think my sleep is mainly disturbed by pain, mood, breathing, bladder, medication or something else?”
• “Are there any checks we should do before adding a sleep tablet?” (for example, blood tests, medication review, mood or memory assessment).

If a tablet is added without exploring these underlying issues, it may partly “cover” the problem without really tackling it – and then be difficult to stop later.

2. “What medicine are you suggesting – and why this one for me?”

Ask your prescriber to write down:

• The name of the tablet (brand and generic).
• The type of medicine it is (for example, z-drug, benzodiazepine, melatonin, sedating antidepressant).
• Why they think it might help in your situation.

You might say:

• “Are there particular risks with this tablet at my age or with my conditions?”
• “Is there a non-drug option we should try first, such as sleep routines, PHAT exercise, pain review or talking therapy?”

3. “How long is ‘short term’ in my case?”

Guidelines usually say sleep tablets should be prescribed for a short period only (often a few days to a few weeks) at the lowest effective dose, especially in older adults. Yet many people find themselves still taking them years later.

You can ask:

• “What is the planned length of this prescription?”
• “When will we review whether it is helping?”
• “Can we write down our plan for reducing and stopping, if it works in the short term?”

4. “What side effects should we watch for – especially falls and thinking?”

Side effects that matter especially in later life include:

• Morning drowsiness, grogginess or poor concentration.
• Unsteadiness, slower movements and increased falls.
• Confusion, hallucinations or memory problems.
• Low mood, irritability or personality changes.
• Breathing problems at night in people with lung or heart disease or sleep apnoea.

You might say:

• “Given my history of falls / dizziness / memory problems, how will we minimise extra risk from this tablet?”
• “Which side effects mean I should call you, NHS 111, or 999?”

5. “How will this tablet fit with the rest of my medicines?”

Many older adults take several different medicines. Some combinations can make sedation stronger – for example, sleep tablets taken with strong painkillers, some anxiety tablets, alcohol, or other drugs that affect the brain.

You could ask:

• “Have we checked this against all my other tablets, eye drops, patches, herbal remedies and night-time medicines?”
• “Is there anything I should definitely avoid while I’m on this – for example, alcohol, extra over-the-counter sleep remedies, or certain cold/flu medicines?”

If you’re already taking sleep tablets: you are not to blame

Many older adults were started on sleeping pills years ago, often after a bereavement, crisis, hospital admission or shift work. Over time the dose may have crept up, or the tablet simply became part of the nightly routine.

You have not done anything wrong. These medicines can cause dependence – meaning your body and brain adapt so that stopping suddenly feels very uncomfortable, even if you want to stop.

The safest approach is nearly always to:

• Review your situation with a prescriber you trust.
• Make a plan to change or reduce one medicine at a time.
• Reduce slowly, in small steps, with support – not all at once.

Questions to ask before reducing or stopping sleep tablets

1. “Why are we reviewing this now?”

A review is often triggered by falls, confusion, memory concerns, new illness, hospital admission or simply because you have been on the tablet for a long time. It is OK to ask:

• “What benefits do you think I’m still getting from this tablet?”
• “What risks do you think I’m carrying by staying on it?”

2. “What are my options?”

Complete stopping is not the only possibility. Depending on your situation, your team may suggest:

• Reducing your dose slowly over weeks or months.
• Changing to a medicine that is easier to taper or has a shorter effect.
• Adding non-drug support – such as a PHAT movement routine, sleep education, pain review or talking therapy – before or alongside dose changes.

You can say:

• “Can we go through the pros and cons of each option for me personally?”

3. “What is the step-by-step plan – and what if I struggle?”

Stopping sleep tablets, especially benzodiazepines and Z-drugs, usually needs a gradual programme. Your prescriber may propose a schedule such as reducing the dose a little every few weeks. You do not need to design the schedule yourself, but you deserve to understand it.

Questions you might ask:

• “What will the first step look like – in plain language?”
• “How long will we stay at each step before changing again?”
• “What symptoms count as ‘normal adjustment’, and what would make you want to slow down or pause?”
• “If I have a crisis night, what is the plan? Who do I contact?”

4. “What withdrawal or rebound symptoms should we expect?”

When sleep tablets are reduced too quickly, some people experience:

• Worse sleep for a while (“rebound insomnia”).
• Increased anxiety, restlessness or irritability.
• Shakiness, sweating or palpitations.
• Strange dreams or brief changes in perception.

Most people can manage these with a slow plan and support, but you should always know which symptoms would be worrying – for example, severe confusion, very fast heartbeat, chest pain, seizures or feeling unsafe. Agree in advance when to call the practice, NHS 111 or urgent care.

Preparing for a medication review: a simple checklist

Short appointments can feel rushed. Preparing a one-page summary can help you and your prescriber make better decisions together. Before your review, you might write down:

• All medicines you take at night – including tablets, liquids, drops, patches and over-the-counter products such as “night-time” painkillers or cold remedies.
• Any daytime drowsiness – when it happens, how strong it feels, and whether you have nodded off during meals, conversations or television.
• Falls or near-falls – especially at night or first thing in the morning.
• Changes in memory or thinking noticed by you or others.
• Your sleep pattern for the last one to two weeks – roughly what time you fall asleep, how often you wake, when you get up.
• What matters most to you – for example, “I want to feel safe walking to the toilet at night”, or “I would accept slightly worse sleep if it meant fewer falls”.

Bringing this along – or emailing it in advance if your practice allows – can change the feel of an appointment. You are coming not just with a problem, but with information that helps your prescriber think clearly with you.

Working alongside non-drug sleep support

Sleep tablets are only one tool. In many cases, the most important work happens elsewhere:

• Understanding normal age-related changes in sleep – lighter sleep, earlier waking and more naps can all be part of the picture.
• Creating a calming evening routine – lighting, gentle movement, screen habits and winding down.
• Managing night-time worries – journalling, breathing exercises, talking therapies and faith or community support.
• Reviewing pain, breathlessness and bladder symptoms that keep you up at night.
• Using gentle PHAT movement sessions to support daytime energy and night-time rest.

Our PHAT sleep pathway includes companion guides on how sleep naturally changes with age, calming evening routines, night-time worries, naps and pain. Sleep tablets, if used, should sit within this wider plan, not replace it.

Final reminder: This guide cannot diagnose insomnia, judge the safety of any specific medicine for you, or provide a tapering schedule. It is educational support only. Always speak to your GP, practice pharmacist, specialist nurse, psychiatrist, geriatrician or NHS 111 before starting, changing or stopping sleeping tablets or other sedating medicines. Seek urgent help if you experience severe drowsiness, chest pain, very slow or difficult breathing, a serious fall or sudden confusion.