Even if they go to bed later than usual, they often wake up relatively early due to their sleep-wake cycle. Timed light exposures in the evening can be used to treat these disorders for some elderly patients. A regimented sleep schedule can also be effective.
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, should prescription medication be necessary, the first-line treatment is nonbenzodiazepines (e.g., zolpidem, eszopiclone, zaleplon, and ramelteon) as they have been found to be safer and better tolerated than tricyclic antidepressants, antihistamines, and benzodiazepines.
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.
Cognitive behavioral therapy, sometimes called CBT , can effectively treat long-term sleep problems like insomnia.
Physiologic changes of aging, environmental conditions, and chronic medical illnesses contribute to insomnia in the elderly. Sleep disturbance in the elderly is associated with decreased memory, impaired concentration, and impaired functional performance.
Melatonin: Melatonin is considered one of the safest over-the-counter sleep aids, with few side effects. A prescription drug called ramelteon is designed to mimic the effects of melatonin. Like melatonin, it is not considered habit-forming and it does not affect balance.
QUVIVIQ is a prescription medicine for adults who have trouble falling asleep or staying asleep (insomnia).
Nonbenzodiazepine hypnotics and short-, intermediate-, and long-acting benzodiazepines are associated with increased risk of cognitive impairment, delirium, falls, fractures, and motor vehicle crashes in older adults and should be avoided for the treatment of insomnia.
Cognitive behavioral therapy for insomnia (CBT-I) can help you control or eliminate negative thoughts and actions that keep you awake and is generally recommended as the first line of treatment for people with insomnia. Typically, CBT-I is equally or more effective than sleep medications.
Treating insomnia typically involves sleep-inducing medication, cognitive behavioral therapy for insomnia (CBT-i), or a combination of both of these measures. Positive lifestyle changes may alleviate symptoms for some people, as well.
Insomnia in the Elderly
In elderly individuals, sleep‐maintenance insomnia and early awakening are more common complaints than sleep‐onset insomnia; this is likely due to the age‐related changes in sleep architecture and circadian rhythm described above.
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.
Sleep and Aging
Older adults need about the same amount of sleep as all adults—7 to 9 hours each night. But, older people tend to go to sleep earlier and get up earlier than they did when they were younger. There are many reasons why older people may not get enough sleep at night.
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.
Cognitive-behavioral therapy (CBT) can improve your sleep by changing your behavior before bedtime as well as changing the ways of thinking that keep you from falling asleep. It also focuses on improving relaxation skills and changing lifestyle habits that impact your sleeping patterns.
Is insomnia a mental health condition? According to the National Alliance on Mental Illness, it is rare for insomnia to be an isolated medical or mental health condition. Insomnia is usually a symptom of another condition or a result of lifestyle or environmental factors, such as a work schedule or stress.
The main drugs used to treat RBD are melatonin and clonazepam. Melatonin tends to be prescribed more for people with dementia, as clonazepam may worsen other symptoms of dementia and leave the person feeling drowsy during the day.
Set a quiet, peaceful mood in the evening to help the person relax. Keep the lights low, try to reduce the noise levels, and play soothing music if he or she enjoys it. Try to have the person go to bed at the same time each night. A bedtime routine, such as reading out loud, also may help.
Melatonin supplements are generally safe and are used to treat insomnia. They may modestly improve sleep, which could theoretically lead to long-term protection against Alzheimer's. However, other insomnia treatments may be more effective and experts do not recommend melatonin for elderly people with dementia.