Drugs that cause insomnia in elderly
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Drugs That Cause Insomnia in the Elderly
Introduction to Insomnia in the Elderly
Insomnia is a prevalent issue among the elderly, significantly impacting their quality of life, functional abilities, and overall health. Chronic insomnia affects approximately 57% of the elderly population in the United States, leading to substantial societal costs. The treatment of insomnia in this demographic often involves a combination of psychological/behavioral therapies and pharmacological interventions .
Common Drugs That Cause Insomnia
Benzodiazepines and Non-Benzodiazepine Receptor Agonists
Benzodiazepines, such as triazolam and temazepam, and non-benzodiazepine receptor agonists (non-BzRAs), including zaleplon, zolpidem, and eszopiclone, are commonly prescribed for insomnia. However, these drugs are associated with significant adverse effects, particularly in the elderly. These include an increased risk of dementia, serious injuries, and fractures, which should limit their use . Benzodiazepines, in particular, are discouraged for long-term use in the geriatric population due to their potential for dependence and adverse effects .
Antidepressants
Antidepressants, such as trazodone and doxepin, are often used off-label to treat insomnia. While trazodone can improve sleep quality and continuity, it carries significant risks, including morning grogginess and increased dry mouth . Doxepin, at low doses, has shown some efficacy in improving sleep with a safety profile comparable to placebo, but higher doses are not recommended for the elderly due to potential adverse effects .
Antipsychotics and Other Off-Label Medications
Antipsychotic agents, pramipexole, and tiagabine have been used for insomnia, but they have not been extensively studied in older populations and have considerable adverse effects. Gabapentin may be useful for patients with restless leg syndrome or chronic neuropathic pain but should be used cautiously. Diphenhydramine, a common over-the-counter antihistamine, should be avoided in the elderly due to its anticholinergic effects, which can exacerbate insomnia and other health issues .
Alternative Pharmacological Options
Melatonin and Melatonin Receptor Agonists
Melatonin and melatonin receptor agonists, such as ramelteon, are considered safer alternatives for treating insomnia in the elderly. Melatonin slightly improves sleep onset and duration, although product quality and efficacy may vary . Ramelteon has a minimal adverse effect profile and is effective for reducing sleep-onset latency and increasing total sleep time, making it a valuable first-line option .
Orexin Receptor Antagonists
Orexin receptor antagonists, such as suvorexant and the newer drug daridorexant, have shown promise in treating insomnia in the elderly. Suvorexant improves sleep maintenance with mild adverse effects, including somnolence and residual daytime sedation . Daridorexant has demonstrated dose-dependent improvements in sleep parameters and is well-tolerated, making it a viable option for elderly patients .
Conclusion
The management of insomnia in the elderly requires careful consideration of the risks and benefits of pharmacological treatments. Benzodiazepines and non-BzRAs should be used with caution due to their significant adverse effects. Antidepressants and antipsychotics, while sometimes effective, also carry risks that must be weighed. Safer alternatives, such as melatonin receptor agonists and orexin receptor antagonists, offer promising options for improving sleep in the elderly with fewer adverse effects. Nonpharmacologic interventions, including cognitive behavioral therapy, should always be considered as the first line of treatment.
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