Pharmacotherapy of insomnia in older adults

Independently from age related changes, sleep problems affect 10-15% of the general population and increase with older age as well. Insomnia is the most prevalent and the most researched sleep disturbance. In this chapter, the pharmacological treatment options have been discussed.Pharmacological treatments are categorised as benzodiazepines (BZDs) and non-benzodiazepine receptor agonists (so called Z-drugs), as the most commonly used drug classes, and alternatives including antidepressants, melatonin receptor agonists and orexin receptor antagonists. BZDs and Z-drugs are effective for short-term treatment of insomnia. Older adults, with a higher risk of side-effects, need tailored pre¬scribing which also includes deprescribing. Different antidepressants, including trazodone, tricyclic antidepressants (doxepin), and serotonergic antidepressant (mirtazapine), have sedating properties and are often used for the treatment of insomnia.However, despite the fact that these alternatives have been shown to be more effective than placebo at bettering short-term sleep outcomes, the size of effect is variable and the overall estimation of benefit-to-risk ratio is low. The potential benefits of pharmacotherapy on sleep quality and daytime function in older adults should always be balanced against the risk of side-effects and physical and psychological dependence with long-term use.Independently from age related changes, sleep problems affect 10-15% of the general population and increase with older age as well. Insomnia is the most prevalent and the most researched sleep disturbance. In this chapter, the pharmacological treatment options have been discussed.Pharmacological treatments are categorised as benzodiazepines (BZDs) and non-benzodiazepine receptor agonists (so called Z-drugs), as the most commonly used drug classes, and alternatives including antidepressants, melatonin receptor agonists and orexin receptor antagonists. BZDs and Z-drugs are effective for short-term treatment of insomnia. Older adults, with a higher risk of side-effects, need tailored pre¬scribing which also includes deprescribing. Different antidepressants, including trazodone, tricyclic antidepressants (doxepin), and serotonergic antidepressant (mirtazapine), have sedating properties and are often used for the treatment of insomnia.However, despite the fact that these alternatives have been shown to be more effective than placebo at bettering short-term sleep outcomes, the size of effect is variable and the overall estimation of benefit-to-risk ratio is low. The potential benefits of pharmacotherapy on sleep quality and daytime function in older adults should always be balanced against the risk of side-effects and physical and psychological dependence with long-term use.B