Prevalence of insomnia in elderly general practice attenders and the current treatment modalities.

Department of Psychiatry, University of Freiburg, Germany.
Acta Psychiatrica Scandinavica (Impact Factor: 4.86). 09/1994; 90(2):102-8. DOI: 10.1111/j.1600-0447.1994.tb01563.x
Source: PubMed

ABSTRACT This study aimed to assess the prevalence and treatment modalities of elderly practice attenders. A total of 330 patients aged over 65 years were investigated with a questionnaire in general practice. To assess insomnia, operationalized diagnostic criteria according to DSM-III-R were applied. Twenty-three percent of the elderly patients suffered from severe, 17% from moderate and 17% from mild insomnia. More than 80% of the patients reported suffering from insomnia for 1-5 years or longer, which indicates a chronic course. Elderly patients showed unrealistic expectations concerning duration of sleep and spend more time in bed than they realistically can expect to sleep. More than half of the elderly patients reported habitual daytime napping. Sleep-disturbed elderly patients did not differ significantly from good sleepers in their habit of taking daytime naps, but even when taking daytime naps, good sleepers slept significantly longer than the sleep-disturbed patients. A significant association was found between insomnia and mental disorders, i.e., depression and organic brain syndrome according to the diagnosis of the general physician. In about half of the cases the primary care physician was not aware that the elderly patient suffered from severe insomnia. More than half of the elderly severe insomniacs took prescribed hypnotics habitually, mainly benzodiazepines.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Insomnia affects a significant proportion of the general population and an even greater proportion of patients seen in general medical care. Insomnia has multiple negative effects on health status, decreases quality of life, and is associated with increased health care costs. Current treatments for insomnia include pharmacologic and behavioral strategies. Pharmacologic treatments may be effective for short-term and middle-of-the-night (MOTN) insomnia, but the usefulness of many sleep medications is limited by the residual daytime sedation with which they are associated. This problem is especially important in the case of MOTN insomnia, when only a few hours may elapse between the time a patient takes the medication and when he or she must rise. The development of sublingual and low-dose formulations of zolpidem raises the possibility that pharmacologic therapy may allow patients with MOTN insomnia to be effectively treated with a decreased risk of residual daytime sedation. Current studies of this strategy are promising, and several formulations are in the process of being brought to market.
    Nature and Science of Sleep 01/2010; 2:63-9.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Schlafstörungen gehören zu den häufigsten Beschwerden im Alter. Gründe hierfür sind die Zunahme altersspezifischer Erkrankungen, die mit Schlafstörungen assoziiert sind, deren medikamentöse Behandlung, Veränderungen des cirkadianen Rhythmus und die Zunahme primärer Schlafstörungen. Die altersbedingten physiologischen Veränderungen des Schlafs und die an die Schlafregulation assoziierten Systeme sind selbst keine Ursache für Schlafstörungen, sie können jedoch ein Risiko- oder Vulnerabilitätsfaktor für das Auftreten von Schlafstörungen sein. Ein gestörter Schlaf kann zu Störungen der kognitiven Leistungsfähigkeit und der Tagesbefindlichkeit, aber auch zu metabolischen Störungen führen. Bereits vorbestehende körperliche und mentale Erkrankungen können somit durch die Insomnie intensiviert werden. Das Erkennen einer Schlafstörung und deren diagnostische Einordnung ist daher gerade bei älteren Menschen von großer Relevanz. Die Behandlung von Schlafstörungen richtet sich nach deren Ätiologie und Intensität. Bei sekundären Insomnien steht immer die Behandlung der Grunderkrankung an erster Stelle. Vor Beginn einer symptomatischen Pharmakotherapie sollte in jedem Fall die Möglichkeit nicht-pharmakologischer Interventionen geprüft werden. Einen besonderen Stellenwert nehmen im Alter die chronobiologischen Verfahren ein, die auf eine Optimierung der Tag-Nacht-Kontrastierung abzielen. Bei pharmakologischen Interventionen sind bei älteren Menschen Besonderheiten zu beachten (langsamere Metabolisierung, häufige Co-Morbidität, höhere Nebenwirkungsrate aufgrund von Medikamenteninteraktionen). An medikamentösen Behandlungen stehen für die zeitlich limitierte Behandlung primär die Nicht-Benzodiazepinhypnotika zur Verfügung. Bei längerfristig notwendiger Therapie können schlafanstoßende Antidepressiva und auch hypnotisch wirksame Neuroleptika (jeweils ohne anticholinerge Komponente) eingesetzt werden. Klassische Benzodiazepine, Antihistaminika und Medikamente mit anticholinerger Wirksamkeit sind aufgrund des Nebenwirkungsspektrums bei älteren Menschen, wenn möglich, zu vermeiden. Difficulties in initiating and/or maintaining sleep are prevalent symptoms in late life. Factors which contribute to the increased prevalence of insomnia in the elderly are psychiatric and medical disorders, medications, alterations of the circadian system and the increased prevalence of specific primary sleep disorders. Physiological changes over the life span may be related to a shorter and more shallow sleep in the elderly. However, sleep problems are not a normal part of aging. Therefore, the physiological changes of sleep in the elderly may rather represent a vulnerability marker for the development of insomnia. Sleep disturbance may consequently lead to an impairment of cognitive functions,mood disturbance and metabolic alterations. Thus, pre-existing mental and physical disabilities in late life may be intensified. The confirmation of insomnia and its diagnostic characterization is of major importance in the elderly, as treatment of insomnia is based on its etiology and intensity. For secondary insomnia, treatment of the basic disorder is mandatory. Before the initiation of a symptomatic pharmacological treatment the application of non-pharmacological interventions should be considered, in particular taking chronobiological methods into account. Pharmacological interventions are limited in the elderly by some specific factors, such as slow metabolization processes, co-morbidities, and higher rate of side effects due to pharmacological interactions. Efficacious pharmacological interventions are non-benzodiazepine hypnotics for a limited time only. If longer treatment of insomnia is necessary, hypnotic antidepressants and hypnotic neuroleptics (without anticholinergic action) can be applied taking the specific side effects into account. Classical benzodiazepines and substances with anticholinergic properties should be avoided in the elderly due to the side effect spectrum which may be detrimental in this population.
    Somnologie - Schlafforschung und Schlafmedizin 06/2007; 11(2):84-98.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Insomnia is the most common sleeping disorder, increasing as people get older, which therefore creates an increase in the use of hypnotics. The presence of insomnia in elderly people, according to different authors, ranges between 17 and 43% depending on the criteria of diagnosis used and the group of population studied. The objectives of this study are to determine the prevalence of insomnia in a population of 65 years and over in a Basic Health Area and the medical consumption related to it. A cross sectional study by means of an ad hoc questionnaire about sleeping habits given by medical staff, including social demographic variables, psychotropic medication consumption, cognitive assessment by means of Mini Mental Status Examination and a range of anxiety-depression of Goldberg. Hartman and DSM-IV criteria were used for the insomnia diagnosis. Cuenca I Primary Care Center, Cuenca (Spain). A random sample of 343 patients of a population of 2253, 65 years and over. The prevalence found was 13.6% (Hartman) and 30.7% (DSM-IV) more common amongst women (p < 0.005), sufferers of psychiatric illnesses (p < 0.01) and those at the top-half of the anxiety-depression scale (p < 0.001). A 46.1% suffer from daylight hypersomniac. A 19.1% takes some kind of medication to help them sleep and the 74.6% of them take it daily. Long and short plasma half-life benzodiazepines are the most consumed, with women and insomniacs being the majority consumers. The prevalence of insomnia in our population is slightly inferior to that of other studies and the consumption of sleep-enhancing medication although inappropriate is similar to that referred to in literature.
    Atención Primaria 04/2000; 25(6):400-4. · 0.96 Impact Factor


Available from
May 22, 2014