Insomnia in the elderly.
BACKGROUND
Up to 40% of adults have insomnia, with difficulty getting to sleep, early waking, or feeling unrefreshed on waking. The prevalence of insomnia increases with age. Other risk factors include psychological factors, stress, daytime napping, and hyperarousal.


METHODS
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-drug treatments for insomnia in elderly people? What are the effects of drug treatments for insomnia in elderly people? We searched: Medline, Embase, The Cochrane Library and other important databases up to October 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).


RESULTS
We found 28 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.


CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: benzodiazepines (brotizolam, flurazepam, loprazolam, midazolam, nitrazepam, quazepam, temazepam, and triazolam), cognitive behavioural therapy, diphenhydramine, exercise programmes, timed exposure to bright light, zaleplon, zolpidem, and zopiclone.
Montgomery
Paul
P
University of Oxford, Oxford, UK.
Lilly
Jane
J
D000368:Aged; D015928:Cognitive Behavioral Therapy; D005479:Flurazepam / Q000494:pharmacology; D006801:Humans; D012307:Risk Factors; D012890:Sleep / Q000187:drug effects; D007319:Sleep Initiation and Maintenance Disorders; D013693:Temazepam
D013693:Temazepam; D005479:Flurazepam