Melatonin Therapy: From Benzodiazepine-Dependent Insomnia to Authenticity and Autonomy

Bursztajn, Harold J.

doi:10.1001/archinte.159.20.2393

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…89 Thus, melatonin was felt to be a partial answer to the problems of benzodiazepines. 90 Two randomised trials (7-week placebo-controlled and 4-week crossover) in older people have failed to show efficacy in improving sleep. 91,92 Melatonin has been associated with coronary vasoconstriction.…”

Section: Other Drugsmentioning

confidence: 99%

Managing Insomnia in Older People

Woodward

2007

Pharmacy Practice and Res

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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

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