Insomnia in the elderly and contemporary treatment methods
DOI:
https://doi.org/10.56782/pps.230Keywords:
insomnia, elderly, cognitive-behavioral therapy, sleep hygiene, treatmentAbstract
Introduction: Insomnia is one of the most common health problems of modern times and the third most common reason for presenting to the primary care doctor after headache and gastrointestinal symptoms.
Aim: The aim of this article is to present current treatments for insomnia in older people over 65 years of age, focusing on cognitive-behavioural therapy complemented by pharmacological treatment.
State of the art brief: The prevalence of insomnia can be as high as 19%. The problem mainly affects older people. It is caused not only by the physiological changes occurring in the process of ageing, but also by the numerous diseases from which seniors suffer. Insufficient sleep can lead to many illnesses or aggravate existing ones, which is particularly dangerous for the aforementioned age group. The treatment of insomnia is based on non-pharmacological methods, which include cognitive-behavioral psychotherapy and sleep hygiene education, and on pharmacological treatment, in which a wide range of drugs are used. In daily practice, mainly benzodiazepines and their derivatives, antidepressants and melatonin are used.
Conclusions: Insomnia is a very significant problem worsening daytime functioning, negatively affecting quality of life. Therefore, appropriate diagnosis of sleep disorders is important, as it may facilitate the identification of the potential cause of the disorder and the introduction of appropriate management.
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References
1. Wojtas, A.; Ciszewski, S. Epidemiologia bezsenności. [Epidemiology of insomnia.] Med. Forum. 2011, 8(3),79–83.
2. Wichniak, A.; Bieńkowski, P.; Dąbrowski, R.; Mastalerz-Migas, A.; Rymaszewska, J. Treatment of insomnia in older adults. Recommendations of the Polish Sleep Research Society, Polish Society of Family Medicine and the Polish Psychiatric Association. Psychiatr. Pol. 2023, 57, 495–516. DOI: 10.12740/PP/OnlineFirst/161597 DOI: https://doi.org/10.12740/PP/OnlineFirst/161597
3. Siemiński, M.; Skorupa, Ł.; Wiśniewska-Skorupa, K. Diagnostyka i terapia bezsenności w praktyce ogólnolekarskiej Część I: Epidemiologia, patomechanizm i diagnostyka bezsenności. [Diagnostics and therapy of insomnia in general practice. Part I: Epidemiology, pathomechanism and diagnostics of insomnia.] Forum Medycyny Rodzinnej 2018, 12, 242–251.
4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed.; American Psychiatric Association: Washington, DC, USA, 1994.
5. American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed.; American Academy of Sleep Medicine: Darien, IL, USA, 2014.
6. Skalski, M. Insomnia – pathogenesis and treatment. COSMOS Probl. Biol. Sci. 2014, 63, 233-243.
7. Medycyna Praktyczna. Bezsenność. [Practical Medicine. Insomnia.] Available online: https://www.mp.pl/pacjent/psychiatria/bezsennosc/70349,bezsennosc (accessed on 17 January 2024).
8. Medycyna Praktyczna. Fizjologia snu. Available online: https://www.mp.pl/pacjent/psychiatria/bezsennosc/70378,fizjologia-snu (accessed on 20 January 2024).
9. Gackowski, M.; Mądra-Gackowska, K.; Kędziora-Kornatowska, K.; Koba, M. Farmakoterapia bezsenności u pacjentów w starszym wieku. [Pharmacotherapy for insomnia in older patients.] Geriatrics. 2019, 13, 90-96.
10. Foley, D.J.; Monjan, A.A.; Brown, S.L.; Simonsick, E.M.; Wallace, R.B.; Blazer, D.G. Sleep complaints among elderly persons: An epidemiologic study of three communities. Sleep. 1995, 18, 425-432. DOI: 10.1093/sleep/18.6.425 DOI: https://doi.org/10.1093/sleep/18.6.425
11. Ford, E.S.; Wheaton, A.G.; Cunningham, T.J.; Giles, W.H.; Chapman, D.P.; Croft, J.B. Trends in outpatient visits for insomnia, sleep apnea, and prescriptions for sleep medications among US adults: findings from the National Ambulatory Medical Care survey 1999-2010. Sleep. 2014, 37, 1283-1293. DOI: 10.5665/sleep.3914 DOI: https://doi.org/10.5665/sleep.3914
12. Nowicki, Z.; Grabowski, K.; Cubała, W.J.; Nowicka-Sauer, K.; Zdrojewski, T.; Rutkowski, M.; Bandosz, P. Prevalence of self-reported insomnia in general population of Poland. Psychiatr. Pol. 2016, 50, 165-173. DOI: 10.12740/PP/58771 DOI: https://doi.org/10.12740/PP/58771
13. Schlack, R.; Hapke, U.; Maske, U.; et al. Frequency and distribution of sleep problems and insomnia in the adult population in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt. 2013, 56, 740–748. DOI: 10.1007/s00103-013-1689-2 DOI: https://doi.org/10.1007/s00103-013-1689-2
14. Leger, D.; Guilleminault, C.; Dreyfus, J.P.; et al. Prevalence of insomnia in a survey of 12,778 adults in France. J. Sleep Res. 2000, 9, 35–42. DOI: 10.1046/j.1365-2869.2000.00178.x DOI: https://doi.org/10.1046/j.1365-2869.2000.00178.x
15. Pallesen, S.; Sivertsen, B.; Nordhus, I.H.; et al. A 10-year trend of insomnia prevalence in the adult Norwegian population. Sleep Med. 2014, 15, 173–179. DOI: 10.1016/j.sleep.2013.10.009 DOI: https://doi.org/10.1016/j.sleep.2013.10.009
16. Walacik-Ufnal, E. Zastosowanie terapii poznawczo-behawioralnej w leczeniu bezsenności. [Cognitive behavioral therapy in the treatment of insomnia.] Psychiatry. 2015, 12, 90–98.
17. Wichniak, A.; Iwański, M.; Salbert, J. Diagnoza I leczenie bezsenności u osób starszych. [Diagnosis and treatment of insomnia in the elderly] General Practitioner 2023, 9(5), 272-278.
18. Abad, V.C.; Guilleminault, Ch. Diagnosis and treatment of sleep disorders: a brief review for clinicians. Dialogues Clin. Neurosci. 2003, 5, 371–388. DOI: 10.31887/DCNS.2003.5.4/vabad DOI: https://doi.org/10.31887/DCNS.2003.5.4/vabad
19. Roth, T. Insomnia: Definition, Prevalence, Etiology, and Consequences. J. Clin. Sleep Med. 2007, 3, S7-S10. DOI: https://doi.org/10.5664/jcsm.26929
20. Fernandez-Mendoza, J.; Vgontzas, A.N. Insomnia and Its Impact on Physical and Mental Health. Curr. Psychiatry Rep. 2013, 15, Art. No: 418. DOI: 10.1007/s11920-013-0418-8 DOI: https://doi.org/10.1007/s11920-013-0418-8
21. Kamel, N.S.; Gammack, J.K. Insomnia in the elderly: cause, approach, and treatment. Am. J. Med. 2006, 119, 463-9. DOI: 10.1016/j.amjmed.2005.10.051 DOI: https://doi.org/10.1016/j.amjmed.2005.10.051
22. Sateia, M.J.; Buysse, D.J.; Krystal, A.D.; Neubauer, D.N.; Heald, J.L. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J. Clin. Sleep Med. 2017, 13, 307–349. DOI: 10.5664/jcsm.6470 DOI: https://doi.org/10.5664/jcsm.6470
23. Edinger, J.D.; Arnedt, J.T.; Bertisch, S.M.; Carney, C.E.; Harrington, J.J.; Lichstein, K.L.; Martin, J.L. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J. Clin. Sleep Med. 2021, 17, 255-262. DOI: 10.5664/jcsm.8986 DOI: https://doi.org/10.5664/jcsm.8986
24. Patel, D.; Steinberg, J.; Patel, P. Insomnia in the Elderly: A Review. J. Clin. Sleep Med. 2018, 14, 1017–1024. DOI: 10.5664/jcsm.7172 DOI: https://doi.org/10.5664/jcsm.7172
25. Agravat, A. “Z”-hypnotics versus benzodiazepines for the treatment of insomnia. Prog. Neurol. Psychiatr. 2018, 22, 26–29. DOI:10.1002/pnp.502 DOI: https://doi.org/10.1002/pnp.502
26. Edinoff, A.N.; Wu, N.; Ghaffar, Y.T.; Prejean, R.; Gremillion, R.; Cogburn, M.; Chami, A,A.; Kaye, A.M.; Kaye, A.D. Zolpidem: Efficacy and Side Effects for Insomnia. Health Psychol. Res. 2021, 9, Art. No: 24927 DOI: 10.52965/001c.24927 DOI: https://doi.org/10.52965/001c.24927
27. Abad, V.C.; Guilleminault, C. Insomnia in Elderly Patients: Recommendations for Pharmacological Management. Drugs Aging. 2018, 35, 791-817. DOI: 10.1007/s40266-018-0569-8 DOI: https://doi.org/10.1007/s40266-018-0569-8
28. Rösner, S.; Englbrecht, C.; Wehrle, R.; Hajak, G.; Soyka, M. Eszopiclone for insomnia. Cochrane Database of Syst. Rev. 2018, 10(10), Art. No: CD010703. DOI: 10.1002/14651858.CD010703.pub2 DOI: https://doi.org/10.1002/14651858.CD010703.pub2
29. Soyka, M.; Wild, I.; Caulet, M.; Leontiou, C.; Lugoboni, F.; Hajak, G. Long-term use of benzodiazepines in chronic insomnia: a European perspective, Front. Psychiatry. 2023, 14, Art. No: 1212028. DOI: 10.3389/fpsyt.2023.1212028 DOI: https://doi.org/10.3389/fpsyt.2023.1212028
30. Karsten, J.; Hagenauw, L.A.; Kamphuis, J.; Lancel, M. Low doses of mirtazapine or quetiapine for transient insomnia: A randomised, double-blind, cross-over, placebo-controlled trial. J. Psychopharmacol. 2017, 31, 327–337. DOI: 10.1177/0269881116681399 DOI: https://doi.org/10.1177/0269881116681399
31. Anderson, S.L.; Vande Griend, J.P. Quetiapine for insomnia: A review of the literature. Am. J. Health-Syst. Pharm. 2014, 71(5), 394-402. DOI:10.2146/ajhp130221 DOI: https://doi.org/10.2146/ajhp130221
32. Riemann, D.; Baglioni, C.; Bassetti, C.; Bjorvatn, B.; Dolenc Groselj, L.; Ellis, J.G.; i wsp. European guideline for the diagnosis and treatment of insomnia. J. Sleep Res. 2017, 26, 675–700. DOI: 10.1111/jsr.12594 DOI: https://doi.org/10.1111/jsr.12594
33. Awgul, S.; Uździcki, A.; Żelazny, P.; Pawlik, A. Pharmacotherapy of insomnia – currently existing therapies and new trends in research. Farmacja współczesna [Contemporary pharmacy[]. 2018, 11, 207-214.
34. Berezińska, M.; Lorenc-Duda, A.; Zawilska, J.B. Ramelteon – lek nasenny nowej generacji. [Ramelteon – a new-generation sleep drug.] Farm. Pol. 2010, 66(3), 173-178.
35. Altinyazar, V.; Kiylioglu, N. Insomnia and dementia: is agomelatine treatment helpful? Case report and review of the literature. Ther. Adv. Psychopharmacol. 2016, 6, 263-268. DOI: 10.1177/2045125316646064 DOI: https://doi.org/10.1177/2045125316646064
36. Herring, W.J.; Connor, K.M.; Snyder, E.; Snavely, D.B.; Zhang, Y.; Hutzelmann, J.; Matzura-Wolfe, D.; Benca, R.M.; Krystal, A.D.; Walsh, J.K.; Lines, C.; Roth, T.; Michelson, D. Suvorexant in patients with insomnia: Pooled analyses of three-month data from phase-3 randomized controlled clinical trials. J. Clin. Sleep Med. 2016, 12, 1215–1225. DOI: 10.5664/jcsm.6116 DOI: https://doi.org/10.5664/jcsm.6116
37. Muehlan, C.; Roch, C.; Vaillant, C.; Dingemanse, J. "The orexin story and orexin receptor antagonists for the treatment of insomnia." J. Sleep Res. 2023, 32, Art. No: e13902. DOI: 10.1111/jsr.13902 DOI: https://doi.org/10.1111/jsr.13902
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Copyright (c) 2024 Katarzyna Łysiak, Anna Łysiak, Barbara Maziarz, Paulina Przywara, Natalia Bogumiłło, Julia Ignacak, Kinga Ściurka, Mikołaj Borek, Oliwia Grzelak
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