Diagnosis and management of insomnia in older people

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Insomnia is a common but underrecognized problem in elderly patients. Five basic steps can help clinicians identify and treat insomnia. The first step is to ask a single question about sleep at every new patient visit, which goes a long way toward detection of patients with insomnia. The second step is to perform an initial evaluation of the problem, including symptoms, contributing factors, and effects on daytime function. Step three is to determine whether the patient is in crisis. True sleep emergencies are rare, and in most cases, treatment can be delayed until another appointment can be made for a full evaluation of the problem. A sleep evaluation constitutes the fourth step and focuses mainly on a thorough sleep history; blood tests and polysomnography rarely have a role. The final step is intervention. Nonpharmacological strategies are a mainstay of treatment for chronic insomnia, but hypnotics have a role in treating transient insomnia and chronic insomnia that does not improve with nonpharmacological treatment or treatment of associated primary conditions. Pharmacological therapy usually consists of benzodiazepines with short half-lives or nonbenzodiazepines such as zolpidem and zaleplon, although lack of demonstrated efficacy against sleep maintenance difficulties, one of the primary symptoms of insomnia among older people, limits use of these agents. Emerging nonbenzodiazepine agents such as indiplon and eszopiclone may specifically address sleep maintenance problems in elderly patients and are pending Food and Drug Administration (FDA) approval.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
Volume53
Issue number7 SUPPL.
DOIs
StatePublished - Dec 1 2005
Externally publishedYes

Fingerprint

Sleep Initiation and Maintenance Disorders
Sleep
zaleplon
Maintenance
Therapeutics
Drug Approval
Polysomnography
Hematologic Tests
United States Food and Drug Administration
Hypnotics and Sedatives
Benzodiazepines
Appointments and Schedules
Emergencies
Pharmacology

Keywords

  • Diagnosis
  • Elderly
  • Insomnia
  • Nonpharmacological treatment
  • Pharmacological treatment

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Diagnosis and management of insomnia in older people. / McCall, William Vaughn.

In: Journal of the American Geriatrics Society, Vol. 53, No. 7 SUPPL., 01.12.2005.

Research output: Contribution to journalArticle

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