Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-28T04:29:46.174Z Has data issue: false hasContentIssue false
  • English
  • Français

Insomnia in older people

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  28 June 2010

Paul Montgomery  and
Lindsay D Shepard
Paul Montgomery*
Affiliation:
Centre for Evidence-Based Intervention, University of Oxford, UK
Lindsay D Shepard
Affiliation:
Centre for Evidence-Based Intervention, University of Oxford, UK
*
Address for correspondence: Paul Montgomery, Centre for Evidence-Based Intervention, Barnett House, 32 Wellington Square, Oxford, Oxfordshire OX1 2ER, UK. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Insomnia is a prevalent sleep complaint amongst older people, affecting physical and mental health as well as many aspects of life quality and well-being. For the lack of explicit guidelines for the assessment and treatment of insomnia in older people, this summary of available information represents the best evidence to inform current practice. Clinicians need to be more aware of their patients’ sleep and conduct formal assessments as appropriate. Despite past practice trends, non-pharmacological treatments should be considered first for chronic insomnia as a means to reduce dependency, adverse effects, and polypharmacy. Behavioural treatment methods such as stimulus control and sleep restriction are especially beneficial for older insomniacs as they target maladaptive sleep habits. Pharmacological treatment should be employed only if insomnia persists, involving the careful patient-specific consideration of the lowest effective dose, best intermittence of dosing, shortest effective duration, best gradual discontinuation scheme, and most effective elimination half-life.

Keywords

insomniaelderlytreatmentsleepreview
Type
Clinical geriatrics section
Information
Reviews in Clinical Gerontology , Volume 20 , Issue 3 , August 2010 , pp. 205 - 218
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2005; American Academy of Sleep Medicine, Westchester, IL.Google Scholar
2Tinetti, ME, Speechley, M, Ginter, SF. Risk factors for falls among elderly persons living in the community. New Engl J Med 1988; 319: 1701–7.CrossRefGoogle ScholarPubMed
3Morin, CM, Gramling, SE. Sleep patterns and aging: comparison of older adults with and without insomnia complaints. Psychology Aging 1989; 4: 290–94.CrossRefGoogle ScholarPubMed
4Bliwise, DL. Sleep in normal aging and dementia. Sleep 1993; 16: 40–81.CrossRefGoogle ScholarPubMed
5Hemmelgarn, B, Suissa, S, Huang, A, Boivin, JF, Pinard, G. Benzodiazepine use and the risk of motor vehicle crash in the elderly. JAMA 1997; 278: 27–31.CrossRefGoogle ScholarPubMed
6Brassington, GS, King, AC, Bliwise, DL. Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64–99 years. JAGS 2000; 48: 1234–40.CrossRefGoogle Scholar
7Bain, KT. Management of chronic insomnia in elderly persons. Am J Geriatr Pharmacother 2006; 4: 168–92.CrossRefGoogle ScholarPubMed
8Goktas, K, Ozkan, I. Sleep disorders in the elderly. Turk Geriatri Dergisi 2006; 9: 226–33.Google Scholar
9American Sleep Disorders Association (ASDA). International classification of sleep disorders: Diagnostic and coding manual. Rochester, MN, 1990.Google Scholar
10American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn.Washington, DC: American Psychiatric Association, 1994.Google Scholar
11Buysse, DJ. Diagnosis and classification of insomnia disorders. In Szuba, MP, Kloss, JD, Dinger, DF (eds). Insomnia: Principles and Management. Cambridge, UK: Cambridge University Press, 2003: pp. 3–22.Google Scholar
12Ford, DE, Kamerow, DB. Epidemiologic study of sleep disturbances and psychiatric disorders. JAMA 1989; 262: 1479–84.CrossRefGoogle ScholarPubMed
13Brabbins, CJ, Dewey, ME, Copeland, JRM et al. Insomnia in the elderly: prevalence, gender differences and relationships with morbidity and mortality. Int J Geriatr Psychiatry 1993; 8: 473–80.CrossRefGoogle Scholar
14NCSDR. Wake Up America: A National Sleep Alert Report of the National Commission on Sleep Disorders Research 1993; US Department of Health and Human Services, Washington.Google Scholar
15Foley, DJ, Monjan, AA, Brown, SL, Simonsick, EM, Wallace, RB, Blazer, DG. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 1995; 18: 425–32.CrossRefGoogle ScholarPubMed
16Reid, KJ, Martinovich, Z, Finkel, S, Statsinger, J, Golden, R, Harter, K, Zee, PC. Sleep: A marker of physical and mental health in the elderly. Am J Geriatr Psychiatry 2006; 14: 860–66.CrossRefGoogle ScholarPubMed
17Stepnowsky, CJ Jr, Ancoli-Israel, S. Sleep and its disorders in seniors. Sleep Med Clin 2008; 3: 281–93.CrossRefGoogle ScholarPubMed
18Gallup Organization. Sleep in America: A national survey of US adults. Princeton, NJ, 1991.Google Scholar
19Mellinger, GD, Balter, MB, Uhlenhuth, EH. Insomnia and its treatment: prevalence and correlates. Arch Gen Psychiat 1985; 42: 225–32.CrossRefGoogle ScholarPubMed
20Hohagen, F, Kappler, C, Schramm, E, Rink, K, Weyerer, S, Riemann, D, Berger, M. Prevalence of insomnia in elderly general practice attenders and the current treatment modalities. Acta Psychiatr Scand 1994; 90: 102–8.CrossRefGoogle ScholarPubMed
21Foley, DJ, Monjan, A, Simonsick, EM, Wallace, RB, Blazer, DG. Incidence and remission of insomnia among elderly adults: an epidemiologic study of 6,800 persons over three years. Sleep 1999; 22: S366–72.Google Scholar
22Hidalgo, JLT, Gras, CB, Garcia, YD, Lapeira, JT, Del Campo, JM, Verdejo, MAL. Functional status in the elderly with insomnia. Qual Life Res 2007; 16: 279–86.CrossRefGoogle ScholarPubMed
23Boix Gras, C, Lopez-Torres Hidalgo, J, David Garcia, Y, Tellez Lapeira, J, Villena Ferrer, A, Parraga Martinez, I. Sleep disorders and environmental conditions in the elderly. Atencion Primaria 2009; 41: 564–69.CrossRefGoogle Scholar
24Foley, D, Ancoli-Israel, S, Britz, P, Walsh, J. Sleep disturbances and chronic disease in older adults: Results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res 2004; 56: 497–502.CrossRefGoogle ScholarPubMed
25Morgan, K, Dallosso, H, Ebrahim, S, Arie, T, Fentem, PH. Prevalence, frequency, and duration of hypnotic drug use among elderly living at home. Br Med J 1988; 26: 601–2.CrossRefGoogle Scholar
26Dopheide, JA, Stimmel, GL. Sleep disorders. In Koda-Kimble, MA, Young, LY, Kradjan, WA et al. (eds). Applied Therapeutics: The Clinical Use of Drugs, 8th edn.Philadelphia, PA: Lippincott, Williams & Wilkins; 2005: pp. 1–22.Google Scholar
27Kripke, DF 2001; personal communication (email).Google Scholar
28Bliwise, DL, King, AC, Harris, R, Haskell, W. Prevalence of self-reported poor sleep in a healthy population aged 50–64. Soc Sci Med 1992; 34: 49–55.CrossRefGoogle Scholar
29Manabe, K, Matsui, T, Yamaya, M, Sato-Nakagawa, T, Okamura, N, Arai, H, Sasaki, H. Sleep patterns and mortality among elderly patients in a geriatric hospital. Gerontology 2000; 46: 318–322.CrossRefGoogle Scholar
30Cricco, M, Simonsick, EM, Foley, DJ. The impact of insomnia on cognitive functioning in older adults. JAGS 2001; 49: 1185–89.CrossRefGoogle ScholarPubMed
31Grunstein, R. Insomnia. Diagnosis and management. Aust Fam Physician 2002; 31: 1–6.Google ScholarPubMed
32Schubert, CR, Cruickshanks, KJ, Dalton, DS, Klein, BE, Klein, R, Nondahl, DM. Prevalence of sleep problems and quality of life in an older population. Sleep 2002; 25: 889–93.Google Scholar
33Neubauer, DN. Sleep problems in the elderly. Am Fam Physician 1999; 59: 2551–58, 2559–60.Google ScholarPubMed
34Riedel, BW, Lichstein, KL. Objective sleep measures and subjective sleep satisfaction: how do older adults with insomnia define a good night's sleep? Psychology Aging 1998; 13: 159–63.CrossRefGoogle ScholarPubMed
35Ancoli-Israel, S. Sleep disorders in older adults: A primary care guide to assessing 4 common sleep problems in geriatric patients. Geriatrics 2004; 59: 37–40.Google Scholar
36Sadeh, A, Hauri, PJ, Kripke, DF, Lavie, P. The role of actigraphy in the evaluation of sleep disorders. Sleep 1995; 18: 288–302.CrossRefGoogle ScholarPubMed
37Kamel, NS, Gammack, JK. Insomnia in the elderly: Cause, approach, and treatment. Am J Med 2006; 119: 463–69.CrossRefGoogle ScholarPubMed
38Prinz, PN, Vitaliano, PP, Vitiello, MV, Bokan, J, Raskind, M, Peskind, E, Gerber, C. Sleep, EEG and mental function changes in senile dementia of the Alzheimer's type. Neurobiol Aging 1982; 3: 361–70.CrossRefGoogle ScholarPubMed
39Allen, SR, Seiler, WO, Stahelin, HB, Spiegel, R. Seventy-two hour polygraphic and behavioral recordings of wakefulness and sleep in a hospital geriatric unit: Comparison between demented and non-demented patients. Sleep 1987; 10: 143–59.CrossRefGoogle Scholar
40Vitiello, MV. Sleep disorders in aging. Curr Opin Psychiatry 1996; 9: 284–89.CrossRefGoogle Scholar
41Alessi, CA, Schnelle, JF, MacRae, PG, Ouslander, JG, al-Samarrai, N, Simmons, SF, Traub, S. Does physical activity improve sleep in impaired nursing home residents? JAGS 1995; 43: 1098–102.CrossRefGoogle ScholarPubMed
42Roth, T, Hajak, G, Ustun, TB. Consensus for the pharmacological management of insomnia in the new millennium. Int J Clin Pract 2001; 55: 42–52.CrossRefGoogle ScholarPubMed
43Morin, CM, Hauri, PJ, Espie, CA, Spielman, AJ, Buysse, DJ, Bootzin, RR. Non-pharmacologic treatment of chronic insomnia. Sleep 1999; 22: 1134–56.CrossRefGoogle Scholar
44NIH State-of-the-Science Conference on Manifestations and Management of Chronic Insomnia in Adults; NIH Consensus Science Statement 2005: pp. 1–30.Google Scholar
45Montgomery, P, Dennis, JA. Cognitive behavioural interventions for sleep problems in adults aged 60+ (Cochrane review). Cochrane Database Syst Rev 2003 (1).CrossRefGoogle Scholar
46Baum, C, Kennedy, DL, Knapp, DE, Faich, GE. Drug utilization in the US – 1985: seventh annual review. Rockville, Maryland: Food and Drug Administration 1986.Google Scholar
47Harrington, JJ, Avidan, AY. Treatment of sleep disorders in elderly patients. Curr Treat Options Neurol 2005; 7: 339–52.CrossRefGoogle ScholarPubMed
48Morin, CM, Mimeault, V, Gagne, A. Non-pharmacological treatment of late-life insomnia. J Psychosom Res 1999; 46: 103–16.CrossRefGoogle Scholar
49Lichstein, KL, Riedel, BW. Behavioral assessment and treatment of insomnia: a review with an emphasis on clinical application. Behav Ther 1994; 25: 659–88.CrossRefGoogle Scholar
50Buysse, DJ, Reynolds, CF. Insomnia. In Thorpy, MJ (ed), Handbook of Sleep Disorders. New York: Marcel Dekker 1990.Google Scholar
51Engle-Friedman, M, Bootzin, RR, Hazlewood, L, Tsao, C. An evaluation of behavioral treatments for insomnia in the older adult. J Clin Psychol 1992; 48: 77–90.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
52Edinger, JD, Hoelscher, TJ, Marsh, GR, Lipper, S, Ionescu-Pioggia, M. A cognitive-behavioral therapy for sleep-maintenance insomnia in older adults. Psychol Aging 1992; 7: 282–89.CrossRefGoogle ScholarPubMed
53Morin, CM, Kowatch, RA, Barry, T, Walton, E. Cognitive behavior therapy for late-life insomnia. J Consult Clin Psychol 1993; 61: 137–46.CrossRefGoogle ScholarPubMed
54Morin, CM, Bastien, CH, Brink, D, Brown, TR. Adverse effects of temazepam in older adults with chronic insomnia. Hum Psychopharmacol 2003; 18: 75–82.CrossRefGoogle ScholarPubMed
55Gauriau, C, Raffray, T, Choudat, D, Corman, B, Leger, D. Objective improvement of sleep disorders in the elderly by a health education program. EMBASE Presse Medicale 2007; 36: 1721–31.CrossRefGoogle ScholarPubMed
56De Vanna, M, Rubiera, M, Onor, ML, Aguglia, E. Role of lormetazepam in the treatment of insomnia in the elderly. Clin Drug Invest 2007; 27: 325–332.CrossRefGoogle ScholarPubMed
57Lacks, P, Bertelson, AD, Gans, L, Kunkel, J. The effectiveness of three behavioral treatments for different degrees of sleep-onset insomnia. Behav Ther 1983; 14: 593–605.CrossRefGoogle Scholar
58Morin, CM, Azrin, NH. Stimulus control and imagery training in treating sleep-maintenance insomnia. J Consult Clin Psychol 1987; 55: 260–62.CrossRefGoogle ScholarPubMed
59Morin, CM, Azrin, NH. Behavioral and cognitive treatments of geriatric insomnia. J Consult Clin Psychol 1988; 56: 748–53.CrossRefGoogle ScholarPubMed
60Espie, CA, Lindsay, WR, Brooks, DN, Hood, E, Turvey, T. A controlled comparative investigation of psychological treatments for chronic sleep-onset insomnia. Behav Res Therapy 1989; 27: 79–88.CrossRefGoogle ScholarPubMed
61Friedman, L, Bliwise, DL, Yesavage, JA, Salom, SR. A preliminary study comparing sleep restriction and relaxation treatments for insomnia in older adults. J Gerontol 1991; 46: P1–8.CrossRefGoogle ScholarPubMed
62Anderson, MW, Zendell, SM, Rosa, DP, Rubinstein, ML, Herrera, CO, Simons, O, Caruso, L, Spielman, AJ. Comparison of sleep restriction therapy and stimulus control in older insomniacs: an update. Sleep Res 1988; 17: 141.Google Scholar
63Hoelscher, T, Edinger, JE. Treatment of sleep-maintenance insomnia in older adults: sleep period reduction, sleep education, and modified stimulus control. Psychol Aging 1988; 3: 258–63.CrossRefGoogle ScholarPubMed
64Chesson, AL Jr, Anderson, WM, Littner, M, Davila, D, Hartse, K, Johnson, S, Wise, M, Rafecas, J; Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for the non-pharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine report. Sleep 1999; 22: 1128–33.CrossRefGoogle Scholar
65Montgomery, P, Dennis, JA. Bright light therapy for sleep problems in adults aged 60+ (Cochrane review). Cochrane Database Syst Rev 2002 (2).CrossRefGoogle Scholar
66Fava, M, McCall, WV, Krystal, A, Wessel, T, Rubens, R, Caron, J, Amato, D, Roth, T. Eszopiclone co-administered with fluoxetine in patients with insomnia coexisting with major depressive disorder. Biol Psychiat 2006; 59: 1052–60.CrossRefGoogle ScholarPubMed
67Montgomery, P, Bjornstad, GJ, Dennis, JA. Media-based behavioural treatments for behavioural problems in children (Cochrane review). Cochrane Database Syst Rev 2006 (1).CrossRefGoogle Scholar
68Montgomery, P, Dennis, JA. Physical exercise for sleep problems in adults aged 60+ (Cochrane review). Cochrane Database Syst Rev 2002 (4).CrossRefGoogle Scholar
69Nowell, PD, Mazumdar, S, Buysse, DJ, Dew, MA, Reynolds, CF 3rd, Kupfer, DJ. Benzodiazepines and zolpidem for chronic insomnia: A meta-analysis of treatment efficacy. JAMA 1997; 278: 2170–77.CrossRefGoogle ScholarPubMed
70Mathews, D. Review of insomnia: The sleep cycle and treatment options. Pharm Times 2003; 69: 75–87.Google Scholar
71Kupfer, DJ, Reynolds, CF. Management of insomnia. N Engl J Med 1997; 336: 341–46.CrossRefGoogle ScholarPubMed
72Scharf, MB, Mayleben, DW, Kaffeman, M, Krall, R, Ochs, R. Dose response effects of zolpidem in normal geriatric subjects. J Clin Psychiat 1991; 52: 77–83.Google ScholarPubMed
73Roger, M, Attali, P, Coquelin, JP. Multicenter, double-blind, controlled comparison of zolpidem and triazolam in elderly patients with insomnia. Clin Ther 1993; 15:127–36.Google ScholarPubMed
74Hindmarch, I, Legangneux, E, Stanley, N, Emegbo, S, Dawson, J. A double-blind, placebo-controlled investigation of the residual psychomotor and cognitive effects of zolpidem-MR in healthy elderly volunteers. Br J Clin Pharmacol 2006; 62: 538–45.CrossRefGoogle ScholarPubMed
75Walsh, JK, Soubrane, C, Roth, T. Efficacy and safety of zolpidem extended release in elderly primary insomnia patients. Am J Geriatr Psychiat 2008; 16: 44–57.CrossRefGoogle ScholarPubMed
76Ancoli-Israel, S, Walsh, JK, Mangano, RM, Fujimori, M. Zaleplon, a novel non-benzodiazepine hypnotic, effectively treats insomnia in elderly patients without causing rebound effects. Prim Care Companion J Clin Psychiatry 1999; 1: 114–20.Google Scholar
77Ancoli-Israel, S, Richardson, GS, Mangano, RM. Long-term use of sedative hypnotics in older patients with insomnia. Sleep Med 2005; 6: 107–13.CrossRefGoogle ScholarPubMed
78Glass, J, Lanctot, KL, Herrmann, N, Sproule, BA, Gusto, UE. Sedative hypnotics in older people with insomnia: Meta-analysis of risks and benefits. BMJ 2005; 331: 1169.CrossRefGoogle ScholarPubMed
79Woodward, M. Hypnosedatives in the elderly. A guide to appropriate use. CNS Drugs 1999; 11: 263–79.CrossRefGoogle Scholar
80Petrovic, M, Mariman, A, Warie, H, Afschrift, M, Pevernagie, D. Is there a rationale for prescription of benzodiazepines in the elderly? Review of the literature. Acta Clinica Belgica 2003; 58: 27–36.CrossRefGoogle Scholar
81Grunstein, R. Insomnia. Diagnosis and management. Aust Fam Physician 2002; 31: 1–6.Google ScholarPubMed
82Kummer, J, Guendel, L, Linden, J, Eich, FX, Attali, P, Coquelin, JP, Kyrein, HJ. Long-term polysomnographic study of the efficacy and safety of zolpidem in elderly psychiatric in-patients with insomnia. J Int Med Res 1993; 21: 171–84.Google ScholarPubMed
83Holm, KH, Goa, KL. Zolpidem. An update of its pharmacology, therapeutic efficacy and tolerability in the treatment of insomnia. Drugs 2000; 59: 865–89.CrossRefGoogle ScholarPubMed
84Shochat, T, Loredo, J, Ancoli-Israel, S. Sleep disorders in the elderly. Curr Treat Options Neurol 2001; 3: 19–36.CrossRefGoogle ScholarPubMed
85Hedner, J, Yaeche, R, Emilien, G, Farr, I, Salinas, E; Zaleplon Clinical Investigator Study Group. Zaleplon shortens subjective sleep latency and improves subjective sleep quality in elderly patients with insomnia. Int J Geriatr Psychiat 2000; 15: 704–12.3.0.CO;2-S>CrossRefGoogle ScholarPubMed
86Barbera, J, Shapiro, C. Benefit-risk assessment of zaleplon in the treatment of insomnia. Drug Saf 2005; 28: 301–18.CrossRefGoogle ScholarPubMed
87Sproule, BA, Busto, UE, Buckle, C, Herrmann, N, Bowles, S.The use of non-prescription sleep products in the elderly. Int J Geriatr Psychiatry 1999; 14: 851–57.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
88Garfinkel, D, Laudon, M, Nof, D, Zisapel, N. Improvement of sleep quality in elderly people by controlled-release melatonin. Lancet 1995; 346: 541–44.CrossRefGoogle ScholarPubMed
89Haimov, I, Lavie, P. Potential of melatonin replacement therapy in older patients with sleep disorders. Drugs Aging 1995; 7: 75–78.CrossRefGoogle ScholarPubMed
90Luthringer, R, Muzet, M, Zisapel, N, Staner, L. The effect of prolonged-release melatonin on sleep measures and psychomotor performance in elderly patients with insomnia. Int Clin Psychopharmacol 2009; 24: 239–49.CrossRefGoogle ScholarPubMed
91Agostini, JV, Leo-Summers, LS, Inouye, SK. Cognitive and other adverse effects of diphenhydramine use in hospitalized older patients. Arch Intern Med 2001; 161: 2091–97.CrossRefGoogle ScholarPubMed