Insomnia in the elderly: A review for the primary care practitioner
ABSTRACT The elderly are known to have a high prevalence of insomnia. Causes of insomnia include: medical, psychiatric, and drug issues; circadian rhythm changes; sleep disorders; and psychosocial factors. The elderly frequently use sleeping aids. Risks associated with elderly patients' use of hypnotic drugs are attributable to concomitant comorbid conditions, use of multiple medications, altered pharmacokinetics, and increased central nervous system sensitivity to these drugs. Treatment options for insomnia include behavior modification and pharmacotherapy. The choice of hypnotics is based on matching 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 night but no residual daytime effects, and no adverse effects. The longer-acting agents have been shown to result in a higher risk of falls and hip fractures in the elderly. This relationship is not apparent with short-acting agents. 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 elderly. Zaleplon does not appear to cause rebound insomnia, residual sedation, or adversely affect psychomotor function. The key for the healthcare professional is finding the appropriate treatment or treatment combination, including behavioral modification and pharmacotherapy. When hypnotics are indicated, the most appropriate short-acting agent should be considered.
- SourceAvailable from: Liang-Wen Hang
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- "Compared to young adults, polysomnography(PSG- ) derived sleep architecture in older adults presents with increased NREM Stage 1 sleep and reduced amounts or absence of NREM Stage 3 and 4 sleep, indicating less deep sleep (or slow wave sleep) but more light sleep in those subjects  . The proportion of REM sleep stays the same but the latency of REM sleep may shorten, resulting in advanced sleep phase and increase in early morning awakening . Consequently, sleep disturbance is highly associated with fatigue, daytime sleepiness, psychological distress, and physical discomfort and, thereby impairing daytime functioning, quality of life as well as physical and mental health    . "
ABSTRACT: Study Objectives. To examine the stimulation effect of auricular magnetic press pellet therapy on older female adults with sleep disturbance as determined by polysomnography (PSG). Design. Randomized, single-blind, experimental-controlled, parallel-group. Setting. Community. Participants. Twenty-seven older female adults with sleep disturbance according to the Pittsburgh Sleep Quality Index (PSQI) >5 for at least 3 months were recruited. Participants were screened by both the Hospital Anxiety and Depression Scale (HADS) and the Mini-Mental State Examination (MMSE), as well as polysomnography prior to randomization. Interventions. All eligible participants were randomly allocated into the experimental or control group. Both groups were taped with magnetic press pellet on auricular points for 3 weeks. The experimental group was treated by applying pressure on the magnetic press pellets 3 times per day while no stimulation was applied on the control group. Measurements and Results. Both groups were measured by PSG and PSQI at the beginning of the study and 3 weeks after the study. Both groups showed improvements on PSQI scores compared to the baseline. One-way analysis of covariance adjusted for baseline scores showed that significant improvements of PSG-derived sleep parameters, such as sleep efficiency, were found in the experimental group. However, no significant differences between groups were observed in the proportion of sleep stages with the exception of Stage 2. Conclusions. Auricular therapy using magnetic pellets and stimulation by pressing was more effective in improving the sleep quality compared to auricular therapy without any stimulation.Evidence-based Complementary and Alternative Medicine 03/2013; 2013:530438. DOI:10.1155/2013/530438 · 1.88 Impact Factor
Handbook of Clinical Neurology 01/2011; 98:653-65. DOI:10.1016/B978-0-444-52006-7.00041-1
- "There are a variety of factors associated with the development of insomnia in the elderly including depression and psychological distress, medical conditions, medications, and circadian rhythm disturbances (Ancoli-Israel 2000). Foley et al. (Foley, Monjan, Simonsick, Wallace, & Blazer 1999) reported that while 28% of older adults suffered from complaints of chronic insomnia, only 7% of the incident cases of insomnia in the elderly occur in the absence of one of these risk factors. "
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- "From an etiologic point of view, this sleep disorder can be characterized as primary insomnia, which does not result from physical or mental factors . In contrast, secondary insomnia is caused by factors, such as psychological, psychosocial, or drug dependency . However, occasionally there is no definite causal relationship between precipitating factors and the occurrence of insomnia ; hence, this form of insomnia could be considered a comorbid condition . "
ABSTRACT: Chinese herbal medicine (CHM) has been commonly used for treating insomnia in Asian countries for centuries. The aim of this study was to conduct a large-scale pharmaco-epidemiologic study and evaluate the frequency and patterns of CHM use in treating insomnia. We obtained the traditional Chinese medicine (TCM) outpatient claims from the National Health Insurance in Taiwan for the year 2002. Patients with insomnia were identified from the diagnostic code of International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed, and an association rule was applied to evaluate the co-prescription of CHM. Results showed that there were 16 134 subjects who visited TCM clinics for insomnia in Taiwan during 2002 and received a total of 29 801 CHM prescriptions. Subjects between 40 and 49 years of age comprised the largest number of those treated (25.3%). In addition, female subjects used CHMs for insomnia more frequently than male subjects (female : male = 1.94 : 1). There was an average of 4.8 items prescribed in the form of either an individual Chinese herb or formula in a single CHM prescription for insomnia. Shou-wu-teng (Polygonum multiflorum) was the most commonly prescribed single Chinese herb, while Suan-zao-ren-tang was the most commonly prescribed Chinese herbal formula. According to the association rule, the most commonly prescribed CHM drug combination was Suan-zao-ren-tang plus Long-dan-xie-gan-tang, while the most commonly prescribed triple drug combination was Suan-zao-ren-tang, Albizia julibrissin, and P. multiflorum. Nevertheless, further clinical trials are needed to evaluate the efficacy and safety of these CHMs for treating insomnia.Evidence-based Complementary and Alternative Medicine 05/2009; 2011(1741-427X):236341. DOI:10.1093/ecam/nep018 · 1.88 Impact Factor