Insomnia in older adults

Insomnia disorder in older adults is associated with dissatisfaction with quality or quantity of sleep and is also associated with difficulty falling asleep, maintaining sleep, or early morning awakening. It is frequently as¬sociated with an age-related decrease in restorative stage 3 of nonrapid eye movement sleep as well as advance phase shift leading to early morning awakening. Sleep disturbances in older adults, as in younger patients, have a bidirectional relationship with many medical and psychiatric disorders as well as polypharmacy. The health con-sequences of insomnia in the elderly may also include manifestation or magnification of cognitive deficits. Di-agnosis of insomnia is based on history from the patient, the bed partner, self-administered questionnaire or sleep di¬ary, comprehensive evaluation for co¬morbid medical/psychiatric disorders, and comprehensive medication history. Both nonpharmacological and pharma¬cological strategies are effective in the management of insomnia. Cognitive-behavioral therapy for insomnia (CBT-I) should be considered as an ini¬tial intervention for chronic insomnia. Pharmacological treatment with short-acting hypnotics is a valuable adjunct to CBT-I for acute insomnia for a brief period followed by a slow taper. Any treatment intervention should be in collaboration with the patient and/or family and include a discussion of the risks, benefits, and costs.