Review of Safety and Efficacy of Sleep Medicines in Older Adults

Abstract

An ideal treatment for insomnia should help to improve sleep latency and sleep duration with limited awakenings and be without significant adverse effects such as daytime somnolence or decreased alertness. Cognitive behavioral therapy should always be first line treatment. Clinical inertia regarding previous prominent use of benzodiazepines and non-BzRAs will be a significant challenge for patients accustomed to their issuance. The future direction of insomnia treatment should have an emphasis on nonpharmacologic interventions, treating comorbid conditions, and focusing therapy on using benzodiazepines and non-BzRAs as last resorts.

GABA A receptor positive allosteric modulators modify the abuse-related behavioral and neurochemical effects of methamphetamine in rhesus monkeys

“…The high efficacy with which classic benzodiazepine drugs act at GABA A receptors seems to be related to their nonselective action at GABA A receptors containing α1, 2, 3, and 5 subunits (Smith et al, 2001). In fact, despite being FDA-approved for the treatment of insomnia, temazepam has been shown to exert several side effects in humans (Hansen et al, 2015; Schroeck et al, 2016), which is consistent with it being a high efficacy positive modulator at GABA A receptors with lack of α subunit specificity (Heel et al, 1981). Nevertheless, newer GABAergic modulators, such as z-drugs, seem to have lesser efficacy at the GABA A receptor compared to classic benzodiazepines.…”

Sleep and Long-Term Care

“…Valerian and melatonin are the most commonly studied supplements for sleep disorders, but quality studies are limited and often offer conflicting results. 66 The potential drug interactions when using supplements remains unclear and may pose risks to LTC residents. 66,67 The prolonged use of valerian has not been well-studied and there is no documentation of extended use in the elderly population.…”

“…66 The potential drug interactions when using supplements remains unclear and may pose risks to LTC residents. 66,67 The prolonged use of valerian has not been well-studied and there is no documentation of extended use in the elderly population. 66 In a multicenter study from 157 individuals with Alzheimer’s disease, the use of melatonin did not improve objective sleep measures, although caregivers reported subjective improvements of sleep quality.…”

“…66,67 The prolonged use of valerian has not been well-studied and there is no documentation of extended use in the elderly population. 66 In a multicenter study from 157 individuals with Alzheimer’s disease, the use of melatonin did not improve objective sleep measures, although caregivers reported subjective improvements of sleep quality. 68 Safety concerns exist when using melatonin, especially in the elderly, including the potential for residual daytime sedation and prolonged duration of action.…”

Further evaluation of the potential anxiolytic activity of imidazo[1,5- a ][1,4]diazepin agents selective for α2/3-containing GABA A receptors

“…These agents are acutely active unlike the SSRI anti-anxiety drugs (Katz et al, 2004). Despite their relative safety (Woods et al, 1987; Schroeck et al, 2016) and over-the-counter sales in many countries, benzodiazepine anxiolytics have come under scrutiny in the last few decades due to reports of abuse and dependence and concerns of drug interactions (e.g., ethanol) (Kaplan and Dupont, 2005). Further, the motoric effects of ataxia and myorelaxation have raised concerns with potential impact on daily function (e.g., driving cars) (Strand et al, 2016).…”