Assisting Seniors With Insomnia: A Comprehensive Approach

Darrell Hulisz, RPh, PharmD; Christine Duff, PharmD Candidate


US Pharmacist. 2009;34(6):38-43. 

In This Article


Insomnia that worsens or persists beyond 3 weeks may signal an underlying medical, psychiatric, iatrogenic, or psychosocial disorder. The pharmacist should refer these patients for medical follow-up. The pharmacist may wish to consider providing feedback to a patient's physician whenever treatable or reversible causes of insomnia are suspected, especially in drug-induced cases.

In the elderly, nonbenzodiazepines such as zolpidem, eszopiclone, zaleplon, and ramelteon are safer and better tolerated than tricyclic antidepressants, antihistamines, and benzodiazepines. Pharmacotherapy should be recommended only after sleep hygiene is addressed, however. Patients with chronic insomnia may be advised to contact national organizations that provide free support materials to people suffering from insomnia (Table 5). The pharmacist also can refer patients to a sleep specialist, if available. Finally, the pharmacist should promote principles of good sleep hygiene and take a thorough medication history to rule out any iatrogenic causes of the insomnia.


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