Pharmacologic treatment of disturbed sleep in the elderly.

Harvard Medical School, Boston, MA, USA. carl
Harvard Review of Psychiatry (Impact Factor: 2.49). 01/2008; 16(5):271-8. DOI: 10.1080/10673220802432442
Source: PubMed

ABSTRACT Disturbed sleep is common in the elderly, who, as a group, take a disproportionately large number of hypnotic medications. Benzodiazepine hypnotics, as well as the newer benzodiazepine receptor agonists, are the primary treatments for these late-life sleep disorders and are effective and safe when used within recommended prescribing guidelines. The elderly also receive other psychiatric medications to induce sleep, although these are off-label uses not well supported by research literature. There is also no literature support for the use of over-the-counter sleep preparations, although both melatonin and a melatonin receptor agonist appear to be moderately effective and safe. Prescribing guidelines for the elderly continue to emphasize short-term, low-dose use, with short-half-life medications. Hypnotic drugs should be used in conjunction with nonmedication treatments, including appropriate sleep hygiene practice, and treatment of other medical or psychiatric causes of disturbed sleep.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Discovered in the late 1950s by Leo Sternbach, the first benzodiazepine (BZD) chlordiazepoxide was followed by several congeners, which rapidly constituted one of the largest and most widely prescribed classes of psychotropic compounds. After 50 years, BZDs are still routinely utilized not only in psychiatry but, more generally, in the whole of medicine. Despite their high therapeutic index which makes BZDs safer than other compounds like barbiturates, as well as their rapidity of onset, psychiatrists and family physicians are well aware about the controversy that surrounds the wide use - often not adequately based on scientific evidence - of BZDs in many psychiatric disorders. In this overview of international treatment guidelines, systematic reviews and randomized clinical trials, the aim was to provide a critical appraisal of the current use and role of BZDs in psychiatric disorders and their disadvantages, with specific emphasis on anxiety and affective disorders, sleep disorders, alcohol withdrawal, violent and aggressive behaviours in psychoses, and neuroleptic-induced disorders. In addition, specific emphasis has been given to the extent of usage of BZDs and its appropriateness through the assessment of available international surveys. Finally, the entire spectrum of BZD-related adverse effects including psychomotor effects, use in the elderly, paradoxical reactions, tolerance and rebound, teratologic risk, dependence, withdrawal and abuse issues was examined in detail.
    European Psychiatry 04/2012; 28(1). DOI:10.1016/j.eurpsy.2011.11.003 · 3.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The most common complaints of older adults concern their difficulty initiating or maintaining sleep, which results in insufficient sleep and an increased risk of falls, difficulty with concentration and memory, and overall decreased quality of life. Difficulties sleeping are not, however, an inevitable part of aging. Rather, the sleep complaints are often comorbid with medical and psychiatric illness, associated with the medications used to treat those illnesses, or the result of circadian rhythm changes or other sleep disorders. Health care professionals specializing in geriatrics need to learn to recognize the different causes of sleep disturbances in this population and to initiate appropriate treatment. Nonpharmacological treatment techniques are discussed; pharmacological treatments are discussed in a companion article.
    Harvard Review of Psychiatry 01/2008; 16(5):279-86. DOI:10.1080/10673220802432210 · 2.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aging of the world’s population has resulted in a new demographic phenomenon: a significant increase in the percentage of elderly compared with the general population. Between 1960 and 1990, the general population in the U.S. increased by less than 50%, while those over 65 increased by almost 100%, and those over 85 years of age increased by almost 250% (1).
    12/2010: pages 125-183;