Changes in sleep occur as individuals age, and management of insomnia should reflect those changes. There are age-related changes that affect pharmacodynamics and pharmacokinetics, altering drug metabolism. Drug clearance can be significantly reduced because of age-related declines in hepatic blood flow and glomerular filtration, complicating pharmacotherapy. Shorter-acting prescription hypnotics, which are compatible with age-related changes in drug metabolism, are preferable pharmacotherapy for insomnia in older patients.
This was one conclusion of a recent review in Medscape Neurology & Neurosurgery (November 2005) on the management of insomnia in elderly patients. Furthermore, researchers noted that sleep architecture is altered as one ages. Seniors spend less time in slow-wave sleep and experience less deep sleep during this stage.
The researchers also observed that insomnia in these patients often is overlooked. They reported that as many as 40% of patients over the age of 60 may experience insomnia, frequent awakening, and disrupted sleep. The investigators believe that untreated insomnia, often associated with depressive symptoms, is clinically as important and debilitating as untreated depression or undertreated hypertension.
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