Effects of chronic insomnia and use of benzodiazepines on daytime performance in older adults

This study evaluated the impact of insomnia and chronic use of benzodiazepi nes on the cognitive and psychomotor performance of older adults. Three con ditions, matched on age, gender, and education, were compared: 20 prolonged users of benzodiazepines for insomnia, 20 unmedicated insomniacs, and 20 g ood sleepers. The participants completed neuropsychological tests of memory , attention/concentration, psychomotor speed, and executive functions, as w ell as subjective evaluations of their actual performance. Individuals with insomnia, both medicated and unmedicated, performed worse than good sleepe rs on the attention/concentration factor. There was no other objective evid ence of performance impairments. However, unmedicated insomniacs had lower performance expectancies and subjectively rated their performance more nega tively relative to medicated insomniacs and good sleepers. Both insomnia co nditions also rated their performance as lower compared with their perceive d potential. It is suggested that the attention/concentration difficulties experienced by medicated and unmedicated older adults with insomnia may be linked to a state of hyperarousal. The discrepancies between subjective rep orts of daytime deficits and objective impairments may reflect a generalize d faulty appraisal of sleep and daytime functioning among individuals with insomnia complaints. The implications of those findings for the assessment and treatment of late-life insomnia are discussed.