Pharmacologic treatment of disturbed sleep in the elderly.
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.
Salzman
Carl
C
Harvard Medical School, Boston, MA, USA. carl salzman@hms.harvard.edu
D000368:Aged; D001521:Behavior Therapy; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004347:Drug Interactions; D058785:GABA-A Receptor Agonists; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008550:Melatonin / Q000009:adverse effects / Q000627:therapeutic use; D044094:Receptors, Melatonin / Q000819:agonists; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*
D058785:GABA-A Receptor Agonists; D006993:Hypnotics and Sedatives; D044094:Receptors, Melatonin; D001569:Benzodiazepines; D008550:Melatonin