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insomnia in the elderly
Management:
- cognitive behavioral therapy (CBT) & sleep hygiene first-line treatment
- more effective than medications for long-term management of insomnia
- CBT & sleep hygiene in combination with medication
- the choice of a hypnotic agent in the elderly is based on symptoms
- sleep-onset insomnia: ramelteon or short-acting Z-drugs
- sleep maintenance: suvorexant or low-dose doxepin
- both sleep onset & sleep maintenance: eszopiclone or zolpidem extended release
- middle-of-the-night awakenings: Low-dose zolpidem sublingual tablets or zaleplon
- other
- benzodiazepines not for routine use
- trazodone improves sleep quality & sleep continuity, risk considered significant
- tiagabine is not effective
- melatonin slightly improves sleep onset & sleep duration
- product quality & efficacy may vary
- extended-release melatonin first line in post menopausal women [5]
- the American Academy of Sleep Medicine recommends against use of melatonin due to lack of evidence of effectiveness [6]
- tryptophan diminishes sleep onset in adults
- data in the elderly are not available
- valerian is safe but benefits on sleep quality are equivocal
- dual orexin receptor antagonist lemborexant may improve sleep maintenance & sleep continuity
- oral magnesium < 1 g up to 3 times/day may be of benefit [3]
General
insomnia
References
- Patel D, Steinberg J, Patel P.
Insomnia in the Elderly: A Review.
J Clin Sleep Med. 2018 Jun 15;14(6):1017-1024.
PMID: 29852897 PMCID: PMC5991956 Free PMC article. Review.
- Abad VC, Guilleminault C.
Insomnia in Elderly Patients: Recommendations for Pharmacological Management.
Drugs Aging. 2018 Sep;35(9):791-817. doi: 10.1007/s40266-018-0569-8.
PMID: 30058034 Review.
- Mah J, Pitre T
Oral magnesium supplementation for insomnia in older adults: a Systematic Review & Meta-Analysis.
BMC Complement Med Ther. 2021 Apr 17;21(1):125.
PMID: 33865376 PMCID: PMC8053283 Free PMC article.
- Brewster GS, Riegel B, Gehrman PR.
Insomnia in the Older Adult.
Sleep Med Clin. 2022 Jun;17(2):233-239.
PMID: 35659076 Review.
- Brewster GS, Riegel B, Gehrman PR.
Insomnia in the Older Adult.
Sleep Med Clin. 2018 Mar;13(1):13-19.
PMID: 29412980 PMCID: PMC5847293 Free PMC article. Review.
- Proserpio P, Marra S, Campana C
Insomnia and menopause: a narrative review on mechanisms and treatments.
Climacteric. 2020 Dec;23(6):539-549.
PMID: 32880197 Review.
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022