What are treatment options for insomnia in elderly patients?

Updated: Sep 11, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Answer

The satisfaction of sleep declines with age. This probably is related to changes in sleep associated with age, such as a decrease in slow-wave sleep, increased time awake after sleep onset, and a tendency to go to bed early and rise early. Although napping is highly prevalent among elderly persons, it has not been consistently correlated with sleep disturbance. [102]

However, aging should not be assumed to be the explanation for insomnia. [103] Multiple factors affect sleep in the elderly, including nocturia, pain syndromes, and many medical disorders (eg, heart failure, chronic obstructive pulmonary disease, Parkinson disease). Other factors include restless legs syndrome, sleep apnea (all of which have increased frequency in the elderly), dementia, and, frequently, changing situational factors such as retirement, bereavement, or financial difficulties, which lead to anxiety and depression. [104]

As in younger patients, nonpharmacologic treatment should take precedence over pharmacologic treatment. Psychological and behavioral interventions are effective in older adults, according to the 2008 AASM guideline. [1] A 16-week randomized, controlled trial by Reid et al found that aerobic activity plus sleep hygiene improved sleep quality, mood, and quality of life in older adults with chronic insomnia. [105]

In elderly patients, hypnotics should be prescribed cautiously and in lower doses than for younger patients. Drugs tend to have a longer duration of effect in elderly patients as a result of changes in metabolism and elimination. This can lead to an increased incidence of falls and resulting bone fractures at night (if the patient gets up to use the bathroom when not fully awake or ataxic) and decrements in daytime alertness and performance (including increased incidence of motor vehicle accidents).


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