Sleep Disorders and Aging (cont.)
IN THIS ARTICLE
Medical Treatment for Sleep Disorders
You may wonder why your health care professional does not just prescribe a sleeping pill for you. The reason is that sleeping pills are linked with many side effects and complications, such as confusion, dizziness, balance problems, fall-related injuries, and daytime "hangover." Seniors should avoid taking these medications for long periods of time. These medications are considered to be only a short-term solution to a sleep problem.
If the sleep problem is caused by a medical or psychiatric problem, your health care provider may treat that condition, or refer you to a specialist. Your health care provider may discontinue or change a medication that impairs sleep.
Medications for Sleep Disorders
The goal of drug therapy is to reduce insomnia without sacrificing daytime alertness. Other names for sleeping medications are hypnotics or sedatives. Usually, a sleeping medication is given only on a 2- to 4-week short-term basis. The underlying cause of the insomnia is treated during this period.
The most widely used sleep medications are the benzodiazepines and benzodiazepinelike drugs. These medications are relatively safe because they are difficult to overdose. Tolerance develops quickly, and over time, a higher dose is required to get the same effect as the initial dose. The risk of becoming dependent on these medications is high. These medications may cause withdrawal symptoms. These are the reasons for using these sleep medications on a short-term basis. Examples are zolpidem (Ambien), lorazepam (Ativan), triazolam (Halcion), temazepam (Restoril), and zaleplon (Sonata). Recent changes in dosing for zolpidem was mandated by the Food and Drug Administration (FDA). Female patients should be started on a lower dose and maximum dose would be 5mg because of differences in clearing the drug from their system.
Antidepressant drugs are sometimes used for people with chronic (long-term) insomnia. These drugs usually work even in people who have no depression. These drugs do not promote dependence. Examples are trazodone (Desyrel) and nefazodone (Serzone). Ramelteon (Rozerem) is a prescription drug that stimulates melatonin receptors. Melatonin is a hormone produced by the pineal gland (located in the brain) during the dark hours of the day-night cycle (circadian rhythm). Melatonin levels in the body are low during daylight hours. The pineal gland responds to darkness by increasing melatonin levels in the body. This process is thought to be integral to maintaining circadian rhythm. Ramelteon promotes the onset of sleep and helps normalize circadian rhythm disorders. Ramelteon is approved by the Food and Drug Administration (FDA) for insomnia characterized by difficulty falling asleep. Suvorexant (Belsomra), is a newer classification of medication for treating insomnia and acts by decreasing the activity in wake system of our brain. For more information on insomnia medications, see Understanding Insomnia Medications.
Follow-up for Sleep Disorders
Your health care provider probably will ask you to return for one or more follow-up visits.
Medically Reviewed by a Doctor on 6/24/2016
Subir Vij, MD, MPH
Anthony M Murro, MD
Mary L Windle, PharmD
Carmel Armon, MD, MHS, MSc
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