What are the risks of using sedating antihistamines for sleep, especially in older adults?

• A. Anticholinergic effects (confusion, delirium, constipation, urinary retention) and daytime sedation; long-term use is inappropriate.
• B. No cognitive effects; they are safe for long-term use.
• C. They improve memory and attention.
• D. They are preferred in older adults due to minimal side effects.

Answer: (A)

Sedating antihistamines carry strong anticholinergic activity, which is especially problematic in older adults. This means they can cause confusion, delirium, and other cognitive disturbances, along with physical effects like constipation, urinary retention, and dry mouth. In addition, the daytime sleepy feeling they produce can impair function and increase the risk of falls the next day. Because older people process these drugs more slowly and are more vulnerable to anticholinergic burden, using them regularly or long-term is not appropriate. Safer sleep options—such as good sleep hygiene or non-sedating alternatives—are preferred.