Insomnia in the elderly: A review for the primary care practitioner

The elderly are known to have a high prevalence of insomnia. Causes of inso mnia include: medical, psychiatric, and drug issues; circadian rhythm chang es; sleep disorders; and psychosocial factors. The elderly frequently use s leeping aids. Risks associated with elderly patients' use of hypnotic drugs are attributable to concomitant comorbid conditions, use of multiple medic ations, altered pharmacokinetics, acid increased central nervous system sen sitivity to these drugs, Treatment options for insomnia include behavior mo dification and pharmacotherapy. The choice of hypnotics is based on matchin g the nature of the insomnia to the hypnotic agent. Benzodiazepine receptor agonists are common hypnotics prescribed for insomnia in the elderly. The ideal agent has rapid onset, duration of action that lasts through the nigh t but no residual daytime effects, and no adverse effects. The longer-actin g agents have been shown to result in a higher risk of falls and hip fractu res in the elderly. This relationship is not apparent with short-acting age nts. Zaleplon, the newest benzodiazepine receptor agonist, has the shortest half-life of available agents. Studies have demonstrated that zaleplon is effective in improving sleep latency, duration, and sleep quality in the el derly. Zaleplon does not appear to cause rebound insomnia, residual sedatio n, or adversely affect psychomotor function. The key for the healthcare pro fessional is finding the appropriate treatment or treatment combination, in cluding behavioral modification and pharmacotherapy. When hypnotics are ind icated, the most appropriate short-acting agent should be considered.