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 Abad2018Schroeck2016.
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 Schroeck2016Sys2019Taylor2009. Benzodiazepines, in particular, are discouraged for long-term use in the geriatric population due to their potential for dependence and adverse effects Schroeck2016Taylor2009.
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 Abad2018Everitt2018. 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 Sys2019Lam2017.
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 Schroeck2016Sys2019.
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 Abad2018Sys2019. 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 Schroeck2016Sys2019.
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 Schroeck2016Sys2019Herring2017. Daridorexant has demonstrated dose-dependent improvements in sleep parameters and is well-tolerated, making it a viable option for elderly patients Zammit2020Fietze2021.
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.
Sources and full results
Most relevant research papers on this topic
Insomnia in Elderly Patients: Recommendations for Pharmacological Management
Pharmacological treatment for insomnia in the elderly should be symptom-based, with FDA-approved drugs and off-label options being effective and safe.
Review of Safety and Efficacy of Sleep Medicines in Older Adults.
Cognitive behavioral therapy and sleep hygiene are recommended for insomnia treatment in older adults, with ramelteon being a valuable first-line option and suvorexant being a potential second-line option.
Review of Insomnia Pharmacotherapy Options for the Elderly: Implications for Managed Care
Insomnia pharmacotherapy options for the elderly include benzodiazepines, benzodiazepine receptor agonists, and melatonin receptor agonists, with melatonin agonists potentially offering a better safety profile.
Insomnia in the elderly: a review for the primary care practitioner.
Zaleplon is an effective short-acting benzodiazepine receptor agonist for improving sleep latency, duration, and quality in the elderly without causing rebound insomnia or adverse effects.
Daridorexant, a new dual orexin receptor antagonist, in elderly subjects with insomnia disorder
Daridorexant, a new dual orexin receptor antagonist, effectively reduces wake after sleep onset and latency to persistent sleep in elderly people with insomnia disorder.
347 Daridorexant is Safe and Improves Both Sleep and Daytime Functioning in Elderly Patients with Insomnia
Daridorexant is a safe and effective treatment for insomnia in elderly patients, improving sleep and daytime functioning without significant adverse events.
Suvorexant in Elderly Patients with Insomnia: Pooled Analyses of Data from Phase III Randomized Controlled Clinical Trials.
Suvorexant effectively improves sleep maintenance and onset in elderly patients with insomnia, and is well-tolerated.
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