Insomnia (primary) in older people.
BACKGROUND
Up to 40% of older 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 older people? What are the effects of drug treatments for insomnia in older people? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2010 (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 34 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: antidepressants, benzodiazepines, cognitive behavioural therapy (CBT), diphenhydramine, exercise programmes, timed exposure to bright light, zaleplon, zolpidem, and zopiclone.
David Geffen School of Medicine at UCLA, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, USA.
Cathy
C
Alessi
Michael V
MV
Vitiello
D015928:Cognitive Behavioral Therapy; D004155:Diphenhydramine / Q000494:pharmacology; D019317:Evidence-Based Medicine; D006801:Humans; D015995:Prevalence; D012890:Sleep / Q000187:drug effects; D007319:Sleep Initiation and Maintenance Disorders
D004155:Diphenhydramine