insomnia in the elderly
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Etiology
- see insomnia
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
- zolpidem not advised due to cognitive & balance problems & risk for fractures[8]
- middle-of-the-night awakenings: Low-dose zolpidem sublingual tablets or zaleplon
- other
- benzodiazepines not for routine use
- 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]
- melatonin should be tried first while awaiting sleep study[6]
- low dose doxepin (only FDA-approved antidepressant)[8]
- may be small improvement in sleep quality with short-term use[9]
- doxepin at lower doses than needed for antidepressant effects is only antidepressant FDA approved for treatment of insomnia[8]
- mirtazapine 7.5 mg reduces chronic insomnia symptoms in elderly people[7]
- use may be limited by mild but clinically relevant adverse effects
- causes daytime sleepiness & reduces sustained attention
- cases of REM behavioral sleep disorder have been reported[6]
- use may be limited by mild but clinically relevant adverse effects
- ramelteon is FDA-approved for treatment of sleep-onset & sleep-maintenance insomnia
- American College of Physicians found weak evidence in support of use elderly[6]
- trazodone improves sleep quality & sleep continuity, risk considered significant
- 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]
- tiagabine is not effective
More general terms
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: https://pubmed.ncbi.nlm.nih.gov/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:http://dx.doi.org/ 10.1007/s40266-018-0569-8. PMID: https://pubmed.ncbi.nlm.nih.gov/30058034 Review.
- ↑ 3.0 3.1 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: https://pubmed.ncbi.nlm.nih.gov/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: https://pubmed.ncbi.nlm.nih.gov/35659076 Review.
Brewster GS, Riegel B, Gehrman PR. Insomnia in the Older Adult. Sleep Med Clin. 2018 Mar;13(1):13-19. PMID: https://pubmed.ncbi.nlm.nih.gov/29412980 PMCID: PMC5847293 Free PMC article. Review. - ↑ 5.0 5.1 Proserpio P, Marra S, Campana C Insomnia and menopause: a narrative review on mechanisms and treatments. Climacteric. 2020 Dec;23(6):539-549. PMID: https://pubmed.ncbi.nlm.nih.gov/32880197 Review.
- ↑ 6.0 6.1 6.2 6.3 6.4 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
Geriatric Review Syllabus (GRS12) Colburn JL, Westcott AM, Potter JF (eds) American Geriatrics Society. 2025 - ↑ 7.0 7.1 Nguyen PV, Dang-Vu TT, Forest G, et al. Mirtazapine for chronic insomnia in older adults: a randomised double-blind placebo-controlled trial-the MIRAGE study. Age Ageing. 2025 Mar 3;54(3):afaf050. PMID: https://pubmed.ncbi.nlm.nih.gov/40135470
- ↑ 8.0 8.1 8.2 8.3 Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
- ↑ 9.0 9.1 Everitt H. Baldwin DS, Stuart B et al Antidepressants for insomnia in adults. Cochrane Database Syst Rev. 2018 May 14;5:CD010753 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/29761479 <Internet> http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD010753.pub2/abstract