![]() Antihistamines: These are generally not preferred in the elderly population due to drug interactions and anticholinergic side effects.Ī.) Diphenhydramine – Increases sleep duration, but not quality. However, they can be an expensive medication.ħ. The big advantage is there is no abuse potential or dependence, rebound insomnia, or withdrawal effects. ![]() Melatonin receptor agonists: These have been shown to reduce sleep latency and increase total sleep time in patients older than 65 with chronic insomnia. It is shown to be less effective for chronic insomnia, but it’s shown to be safe with few side effects.Ħ. Melatonin: This helps regulate the circadian rhythm and is somewhat controversial in use. They can be an option for patients who do not respond to first-line treatments.ĥ. Atypical antipsychotics: These are sometimes used off-label for insomnia and are used in sleep disturbances related to delirium or psychosis. Antidepressants with sedative properties: These can be beneficial for depressed patients.Ī.) Trazodone – Increased risk of daytime sedation, confusion, constipation, and orthostasisī.) Amitriptyline – watch for daytime sedation, anticholinergic effects, and cardiovascular problems.Ĭ.) Mirtazapine –This may be a good option for improving nausea, vomiting, and insomnia, but it cannot be combined with a benzodiazepine.Ĥ. Benzodiazepine receptor agonists: These have a lower potential for addiction as well as rebound insomnia.Ī.) Zolpidem – Short-onset, intermediate duration of action, but no clear advantage over benzodiazepines.ī.) Zaleplon – Ultrashort acting and costly.Ĭ.) Eszopiclone – Short-onset, intermediate duration of action, but no clear advantage over benzodiazepines.ģ. It is also important to be cautious about the risk of falls, paradoxical agitation, cognitive impairment, and respiratory depression when combined with opioids, especially in the elderly.Ī.) Temazepam – Good for sleep induction and maintenance, but risk of daytime drowsiness.ī.) Triazolam – Rapid sleep induction, but not ideal for sleep maintenance.Ĭ.) Lorazepam – Good for sleep induction and maintenance, but there is a risk of daytime drowsiness.ĭ.) Clonazepam – Slow sleep induction, and there is a risk of metabolite accumulation as well as a high risk of daytime sedationĢ. Benzodiazepines have a high risk of amnesia and rebound insomnia. They are recommended for short-term insomnia. Benzodiazepines: These have been shown to decrease the time it takes to fall asleep and increase the duration of sleep as well as reduce night-time awakenings. Below, we explore some of the options available.ġ. Many of these are designed for short-term use as we want to increase sleep hygiene while we use medications to create a better sleep routine. There are multiple medication options when treating insomnia. This includes low impact exercise like leg lifts in bed, stretching, walking, Tai Chi, and yoga.
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