Feature Article

Insomnia in the elderly patient

Feature Article

Insomnia in the elderly patient

Peter A Cistulli, Maria A Fiatarone Singh, Nalin A Singh

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Abstract

Insomnia is recognised as a cause of significant morbidity in the elderly, impacting considerably on quality of life. This article discusses the causes of insomnia in the elderly, and how it can be assessed and managed.

Key Points

  • Chronic illness plays an important role in much of what is thought of as ‘age-related’ changes in sleep. Numerous medical and psychiatric disorders can cause insomnia.
  • A wide range of prescription drugs can cause insomnia in the elderly. Alcohol, caffeine and nicotine are also important causes.
  • History-taking is crucial in establishing the cause of the sleep complaint. A sleep log or diary can clarify the patient’s sleep pattern. The general medical history should focus on relevant diseases and their control, any cause of pain, and a thorough review of all medications.
  • A specific search for the symptoms of depression and anxiety should be made in all cases.
  • Regardless of the underlying cause, it is often wise to address sleep hygiene when managing patients with chronic sleep complaints.
  • Underlying medical causes should be treated.
  • If pharmacotherapy is being considered, the combination of cognitive behavioural therapy with the drug is recommended. The drug would be used in the short term and the behavioural therapy would achieve longer term improvements.