Pharmacologic Treatment of Disturbed Sleep in the Elderly

Abstract

Disturbed sleep is common in the elderly, who, as a group, take a disproportionately large number of hypnotic medications. Benzodiazepine hypnotics, as well as the newer benzodiazepine receptor agonists, are the primary treatments for these late-life sleep disorders and are effective and safe when used within recommended prescribing guidelines. The elderly also receive other psychiatric medications to induce sleep, although these are off-label uses not well supported by research literature. There is also no literature support for the use of over-the-counter sleep preparations, although both melatonin and a melatonin receptor agonist appear to be moderately effective and safe. Prescribing guidelines for the elderly continue to emphasize short-term, low-dose use, with short-half-life medications. Hypnotic drugs should be used in conjunction with nonmedication treatments, including appropriate sleep hygiene practice, and treatment of other medical or psychiatric causes of disturbed sleep.

Sleep in the Elderly: Normal Variations and Common Sleep Disorders

“…Pharmacological interventions have been reviewed in numerous publications 1,4,67,68 and are synthesized in a companion publication. 5 A better approach to treating insomnia, however, is a combination of pharmacological and behavioral therapy. Behavioral therapies are used to modify maladaptive sleep habits, reduce autonomic and cognitive arousal, alter dysfunctional beliefs and attitudes about sleep, and educate patients about healthier sleep practices.…”

Sleep Disturbances in Dementia: What They Are and What To Do

“… Sources: (Ancoli-Israel, Ayalon, & Salzman, 2008; Salzman, 2008; Neubauer, 2008; Ancoli-Israel & Ayalon, 2009; Mintzer & Burns, 2000) …”

Esmirtazapine for the Treatment of Chronic Primary Insomnia: A Randomized Long-Term Safety Study in Elderly Outpatients

“…11,13 Despite being the primary treatments for insomnia in elderly patients, GABAA receptor modulators may not be an ideal treatment for this patient population, as they are associated with impairment of motor function and coordination in elderly patients, along with increased rates of falls and motor vehicle crashes. 14,15 Safety concerns associated with GABAA modulators prompt-ed the clinical development of sleep-promoting compounds that facilitate sleep via more specific and targeted mechanisms of action, and this was anticipated to translate into an improved side-effects profile. For example, orexin receptor antagonists (ORAs) have been developed to promote sleep by blocking physiological effects of the orexin compounds, which are key mediators in the maintenance of arousal and vigilance.…”