Nonpharmacological interventions such as cognitive behavioural therapy and brief behavioural interventions have proven benefit in the management of insomnia in older adults. Epidemiological studies have shown that the risk of motor vehicle accidents, falls and hip fractures leading to hospitalization and death can more than double in older adults taking benzodiazepines and other sedative-hypnotics. Prescribing or discontinuing sedative-hypnotics in hospital can have substantial impact on long-term use. These potential harms and others such as impaired cognition need to be recognized when considering treatment strategies for insomnia. Use of benzodiazepines should be limited to as short a period as possible, in cases where nonpharmacological therapies have failed, and the symptoms of sleep disturbance cause significant suffering or distress.
Sources:
Allain H, et al. Postural instability and consequent falls and hip fractures associated with use of hypnotics in the elderly: a comparative review. Drugs Aging. 2005;22(9):749-65. PMID: 16156679.
American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012 Apr;60(4):616-31. PMID: 22376048.
Finkle WD, et al. Risk of fractures requiring hospitalization after an initial prescription for zolpidem, alprazolam, lorazepam, or diazepam in older adults. J Am Geriatr Soc. 2011 Oct;59(10):1883-90. PMID: 22091502.
Glass J, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005 Nov 19;331(7526):1169. PMID: 16284208.
McMillan JM, et al. Management of insomnia and long-term use of sedative-hypnotic drugs in older patients. CMAJ. 2013 Nov 19;185(17):1499-505. PMID: 24062170.
Rapoport MJ, et al. Benzodiazepines and driving: a meta-analysis. J Clin Psychiatry. 2009 Apr 21;70(5):663-673. PMID: 19389334.
Roszkowska J, et al. Management of insomnia in the geriatric patient. Am J Med. 2010 Dec;123(12):1087-90. PMID: 20870196.
Related Resources:
Patient Pamphlets: Insomnia and Anxiety in Older People: Sleeping pills are usually not the best solution
Toolkit: Less Sedatives for Your Older Relatives – A toolkit for reducing inappropriate use of benzodiazepines and sedative-hypnotics among older adults in hospitals
Toolkit: Drowsy Without Feeling Lousy – A toolkit for reducing inappropriate use of benzodiazepines and sedative-hypnotics among older adults in primary care