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
- trazodone improves sleep quality & sleep continuity, risk considered significant
- mirtazapine 7.5 mg reduces chronic insomnia symptoms in elderly people[7]
- use may be limited by mild but clinically relevant adverse effects
- 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]
- 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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/30058034 Review.
- ↑ Jump up to: 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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/35659076 Review.
Brewster GS, Riegel B, Gehrman PR. Insomnia in the Older Adult. Sleep Med Clin. 2018 Mar;13(1):13-19. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29412980 PMCID: PMC5847293 Free PMC article. Review. - ↑ Jump up to: 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://www.ncbi.nlm.nih.gov/pubmed/32880197 Review.
- ↑ Jump up to: 6.0 6.1 6.2 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ Jump up to: 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://www.ncbi.nlm.nih.gov/pubmed/40135470
- ↑ Jump up to: 8.0 8.1 Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025