Physiologic changes of aging, environmental conditions, and chronic medical illnesses contribute to insomnia in the elderly. Sleep disturbance in the elderly is associated with decreased memory, impaired concentration, and impaired functional performance.
One of the most common sleep disturbances in the older population is insomnia. As many as 50% of older adults complain about difficulty initiating or maintaining sleep. Prevalence of insomnia is higher in older individuals than in the younger population.
Older adults may produce and secrete less melatonin, the hormone that promotes sleep. They may also be more sensitive to changes in their environment, such as noise, and this may cause them to awaken. Further, older adults may also have other medical and psychiatric problems that can affect their sleep.
The choice of a hypnotic agent in the elderly is symptom-based. Ramelteon or short-acting Z-drugs can treat sleep-onset insomnia. Suvorexant or low-dose doxepin can improve sleep maintenance. Eszopiclone or zolpidem extended release can be utilized for both sleep onset and sleep maintenance.
To alleviate sleep problems, people can make behavior modifications including having a regular bedtime, establishing pre-sleep rituals, exercising regularly, and avoiding caffeine, smoking, and alcohol before bedtime.
Tips and tricks
Cognitive behavioral therapy for insomnia (CBT-I) can help you control or eliminate negative thoughts and actions that keep you awake and is generally recommended as the first line of treatment for people with insomnia. Typically, CBT-I is equally or more effective than sleep medications.
Older people wake up more often because they spend less time deep sleep. Other causes include needing to get up and urinate (nocturia), anxiety, and discomfort or pain from long-term (chronic) illnesses. Sleep difficulty is an annoying problem.
Temazepam is the most commonly prescribed benzodiazepine for insomnia. Therefore, based on current utilization patterns, the following section will review pertinent data on temazepam, trazodone, zolpidem, and the newest nonbenzodiazepine—zaleplon—for the treatment of insomnia in elderly patients.