Cognitive behavioral therapy for insomnia (CBT-I) is the preferred first-line treatment for chronic insomnia in adults and has been endorsed as first-line therapy by multiple societies and guideline panels [1-5]. Overall, the evidence base is stronger for CBT-I than for medications.
NEW ORLEANS – Cognitive behavioral therapy (CBT) should be the first-line therapy for insomnia in seniors, but many clinicians are unaware of its benefits, experts say.
Suvorexant or low-dose doxepin can improve sleep maintenance. Eszopiclone or zolpidem extended release can be utilized for both sleep onset and sleep maintenance. Low-dose zolpidem sublingual tablets or zaleplon can alleviate middle-of-the-night awakenings. Benzodiazepines should not be used routinely.
In the elderly, nonbenzodiazepines such as zolpidem, eszopiclone, zaleplon, and ramelteon are safer and better tolerated than tricyclic antidepressants, antihistamines, and benzodiazepines. Pharmacotherapy should be recommended only after sleep hygiene is addressed, however.
Exercise, cognitive behavior therapy, and relaxation therapy are recommended as effective, nonpharmacologic treatments for chronic insomnia. Melatonin is effective in patients with circadian rhythm sleep disorders and is safe when used in the short term.
Medications such as diphenhydramine, doxylamine, and trazodone can be used initially, but patients may not tolerate their side effects. Newer medications such as zolpidem and zaleplon have short half-lives and minimal side effects.
Daridorexant, classified as a DORA, was recently approved in January 2022 by the United States Food and Drug Administration (US FDA) for treating insomnia.
Recent studies have shown that low-dose doxepin improves sleep parameters in older adults with a safety profile comparable to placebo. Higher doses of doxepin should be avoided in older adults because of high anticholinergic side effects. Avoid in patients with glaucoma or urinary retention.
One study. View Source of older adults with insomnia found that magnesium supplementation at a dose of 500 milligrams daily for eight weeks helped them fall asleep fast, stay asleep longer, reduced nighttime awakenings, and increased their levels of naturally circulating melatonin.
As people age, they tend to sleep more lightly and often awaken during the night from achy joints or the need to go to the bathroom. Many people compensate for this lost sleep by catching a restorative nap during the day. That's normal.
Melatonin is generally regarded as safe for seniors by physicians and pharmacists because its side effects are mild, it's not habit forming, and it does not cause withdrawal symptoms if you stop taking it suddenly. However, some of the side effects listed above may present additional challenges for older adults.
Cognitive Behavioral Therapy for Insomnia
CBT-i is considered a first-line treatment for insomnia because it does not carry the health risks. View Source associated with sleep medication. In most cases, CBT-i is provided by a licensed psychologist who has received training for this type of treatment.
The FDA has approved Belsomra® to address insomnia in people living with mild-to-moderate Alzheimer's disease. Belsomra is thought to inhibit the activity of orexin, a type of neurotransmitter involved in the sleep-wake cycle.
Science has shown the benefits of taking Magnesium before bed can help you fall asleep faster, sleep more efficiently, and wake up more refreshed. A study found that participants who consumed 500 mg of Magnesium daily reported reduced insomnia, increased sleep quality, and improved early morning restfulness.
If you are taking magnesium for its restful sleep benefits, taking it with dinner or the last meal of the day may be your best bet.
Dr. Umeda recommends taking the supplement about 30 minutes before bedtime. And don't take more than the recommended amount.
Who is Defined as Elderly? Typically, the elderly has been defined as the chronological age of 65 or older. People from 65 to 74 years old are usually considered early elderly, while those over 75 years old are referred to as late elderly.
Benzodiazepines: Doctors prescribe benzodiazepines to treat insomnia or anxiety that is disabling, severe, and causing extreme distress. Diazepam (Valium), alprazolam (Xanax), and triazolam (Halcion) are examples of benzodiazepines.
Before trying medicine, sleep experts suggest that you start with cognitive behavioral therapy for insomnia (CBT-I). There's less chance of side effects or dependency. And you'll learn strategies that can be helpful for longer.
Daridorexant is FDA approved in doses of 25 mg and 50 mg. In the pivotal trials, doses of 25 mg and 50 mg showed a statistically significant improvement in sleep parameters compared to placebo at both months 1 and 3.
These are the most commonly used sleeping tablets in Australia and include temazepam (Temaze, Normison), zopiclone (Imovane) and zolpidem (Stilnox). They work by enhancing the activity of sleep pathways in the brain. They are recommended for short term use (less than 4 weeks). Melatonin (Circadin).