Managing Insomnia in Older People

Abstract

Although insomnia is a common problem in older people, there have been few therapeutic advances in the last decade. Benzodiazepines continue to be overused and the newer benzodiazepine-like drugs (e.g. zopiclone) are proving to be no more effective and have their own risk of adverse effects. Nonpharmacological management remains the preferred option, but is poorly taught and infrequently adhered to, especially in hospital and residential care settings. Older people themselves often request drugs. Progress towards improved management of insomnia will require a significant shift in knowledge and attitudes in both health professionals and the community. INTRODUCTIONSleep is vital for health and quality of life and older people frequently find sleep elusive. Poor sleep interacts with many medical and psychiatric conditions which are more common in older age, thus exacerbating their morbidity. It would therefore be expected that there have been ongoing and major developments in the understanding and management of insomnia in older people. While some progress has been made there is still a long way to travel before older people with insomnia have a good understanding of sleep disorders, are well assessed, are correctly managed, and participate as informed partners in an effective management program.Changes in the amount and pattern of sleep in older people include spending more time in bed, but less time asleep and easy arousal from sleep, when compared with younger people. 1-5 Average total sleep time actually increases slightly after 65 years of age. 6 Time from retiring to bed and sleep onset increases with age, and there are changes in the quality of sleep. Slow wave (deeper, restorative) sleep reduces with age, there is increased fragmentation of sleep and rapid eye movement (REM) sleep is reduced. 7,8 These changes in sleep and wakefulness with age are in the direction of impaired sleep maintenance and depth. This increased night-time wakefulness is mirrored by increases in daytime fatigue, daytime napping and the likelihood of falling asleep during the day. Advancing age is associated with a tendency to fall asleep by day and to sleep less well at night. These age-related changes in sleep appear to be partly dependent on medical and psychiatric disorders, rather than universal features of normal ageing. 9,10

The association between benzodiazepine use and sleep quality in residential aged care facilities: a cross-sectional study

“…Clinician awareness of preventing adverse events is seen through prescribing habits and patterns. Thus, our findings may reflect channeling of PRN medications to residents susceptible to daytime napping, particularly those with acute rather than chronic insomnia [35]. This study found no association between benzodiazepine use and day-time drowsiness, whereas previous research indicates benzodiazepine users are at a greater risk of somnolence [10, 28].…”

Review of Safety and Efficacy of Sleep Medicines in Older Adults

“…42,43 GABA receptors are present throughout the brain, including the ventral lateral preoptic area that controls sleep. 44 Older adults experience changes in the GABA neurotransmitter system, which results in an increased sensitivity to benzodiazepines and predisposes these patients to ataxia, sedation, and cognitive impairment. 18,45,46 Older patients are more susceptible to the potential adverse effects of benzodiazepines because of altered pharmacokinetics and pharmacodynamics.…”

Role of whey proteins in combating geriatric disorders

“…Insomnia is associated with sleeping difficulty, daytime sleepiness and fatigue, which can lead to impaired cognitive function, cardiovascular diseases, falls, depression, decreased immunity and other poor health conditions. Even though insomnia is quite common, its therapeutic interventions are few . Hence non‐pharmacological management such as stimulus control, sleep restriction, sleep hygiene education, cognitive therapy, multi‐component therapy, paradoxical intention and relaxation therapy remains the preferred option .…”

“…Even though insomnia is quite common, its therapeutic interventions are few. 85 Hence non-pharmacological management such as stimulus control, sleep restriction, sleep hygiene education, cognitive therapy, multi-component therapy, paradoxical intention and relaxation therapy remains the preferred option. 86 Here, nutrition intervention can also play an important role.…”