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. Author manuscript; available in PMC: 2009 Nov 30.
Published in final edited form as: J Am Geriatr Soc. 2007 Oct 3;55(11):1853–1866. doi: 10.1111/j.1532-5415.2007.01399.x

Table 3.

Symptom-management of insomnia in older persons.

Treatment Benefit Risk
Cognitive-Behavioral Therapy161–163
  • Stimulus control
    • Go to bed only when sleepy;
    • Get out of bed when unable to sleep;
    • Use the bedroom for sleep only;
    • Arise at the same time every morning;
    • No napping
 Restores sleep-wake scheduling and the association of the bedroom with sleep None known to date, but implementing these behavioral strategies require expertise, which may not be readily available in many communities; additionally, an appropriate level of motivation, commitment, and understanding are required of the patient.
  • Sleep restriction
    • Curtail time in bed to sleep time; then, gradually increase until optimal sleep duration is achieved
Improves sleep efficiency (the percent of time in bed that is spent asleep)
  • Relaxation techniques
    • Muscle relaxation, imagery, meditation, etc
 Reduce somatic tension and intrusive thoughts at bedtime that are sleep disruptive
  • Cognitive therapy
    • Corrects misconceptions about insomnia and perceived daytime consequences
 Reduces excessive mentation or worrying about insomnia
  • Sleep hygiene
    • Guidelines on health practices, e.g. diet, exercise, substance use (e.g. caffeine, alcohol); and on environmental factors, e.g. light, noise, and temperature – that may promote or disrupt sleep
 Improves health practices and environmental factors that adversely affect sleep
Pharmacotherapy35,116,167–174

  • Sedative-hypnotic sleep aids (benzodiazepines, barbiturates)

  • Nonbenzodiazepine hypnotic sleep aids that act on benzodiazepine receptors (eszopiclone, zaleplon, zolpidem)

  • Melatonin receptor agonists (rozerem)

  • Sedating antidepressants

  • Antihistamines

  • Antipsychotics

  • Benzodiazepenes, nonbenzodiazepine hypnotics, and sedating antidepressants may improve sleep latency and/or sleep continuity.

  • No systematic evidence to support use of barbiturates, antihistamines, antipsychotics, or alternative/complimentary therapies.

  • Benzodiazepines: tolerance, dependency rebound insomnia, anterograde amnesia, ↓cognition, ↓daytime alertness, ↓motor performance, and may ↑ sleep disordered breathing, hypoxemia, and falls; confers higher risk for adverse events than nonbenzodiazepine hypnotics.

  • Rozerem: contraindicated with fluvoxamine.

  • Antidepressants: worsen sleep-related movement disorders, and may lead to falls and REM Behavior Disorder.

  • Antihistamines: should not be used in older persons; reduce daytime alertness and cognition, and can lead to delirium, urinary retention, etc.