Drugs & Aging

, Volume 23, Issue 4, pp 271–287 | Cite as

Use of Sleep-Promoting Medications in Nursing Home Residents

Risks versus Benefits
Current Opinion

Abstract

This paper reviews the use of sleep-promoting medications in nursing home residents with reference to risks versus benefits. Up to two-thirds of elderly people living in institutions experience sleep disturbance. The aetiology of sleep disturbance includes poor sleep hygiene, medical and psychiatric disorders, sleep apnoea, periodic limb movements and restless leg syndrome. One key factor in the development of sleep disturbance in the nursing home is the environment, particularly with respect to high levels of night-time noise and light, low levels of daytime light, and care routines that do not promote sleep. Clinical assessment should include a comprehensive medical, psychiatric and sleep history including a review of prescribed medications. Nonpharmacological interventions for insomnia are underutilised in many clinical settings despite evidence that they are often highly effective.

International studies suggest that 50–80% of nursing home residents have at least one prescription for psychotropic medication. Utilisation rates vary dramatically from country to country and from institution to institution. The most commonly prescribed medications for sleep are benzodiazepines and nonbenzodiazepine hypnotics (Z-drugs). The vast majority of studies of these medications are short-term, i.e. ≤2 weeks, although some longer extension trials have recently been carried out. Clinicians are advised to avoid long-acting benzodiazepines and to use hypnotics for as brief a period as possible, in most cases not exceeding 2–3 weeks of treatment. Patients receiving benzodiazepines are at increased risk of daytime sedation, falls, and cognitive and psychomotor impairment. Zaleplon, zolpidem, zopiclone and eszopiclone may have some advantages over the benzodiazepines, particularly with respect to the development of tolerance and dependence. Ramelteon, a novel agent with high selectivity for melatonin receptors, has recently been approved in the US. Use of the antidepressant trazodone for sleep in nondepressed patients is somewhat controversial. Atypical antipsychotics should not be used to treat insomnia unless there is also evidence of severe behavioural symptoms or psychosis.

Notes

Acknowledgements

We would like to thank Shelly Clancy for her work preparing the manuscript. Dr Conn has received honoraria for speaking or attending advisory boards for the following companies: Astra-Zeneca, Eli Lilly, Janssen, Lundbeck, Novartis, Organon, Pfizer, Wyeth. Dr Madan has no disclosures. No sources of funding were used to assist in the preparation of this review.

References

  1. 1.
    National Institutes of Health. The treatment of sleep disorders of older people. NIH Consens Statement 1990 Mar 26–28; 8(3): 1–22Google Scholar
  2. 2.
    Foley DJ, Monjan AA, Brown SL, et al. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 1995; 18: 425–32PubMedGoogle Scholar
  3. 3.
    Foley DJ, Monjan A, Simonsick EM, et al. Incidence and remission of insomnia among elderly adults: an epidemiologic study of 6800 persons over three years. Sleep 1999; 22(2): S366–72PubMedGoogle Scholar
  4. 4.
    Monane M. Insomnia in the elderly. J Clin Psychiatry 1992; 53(6): 23–8PubMedGoogle Scholar
  5. 5.
    Ohayon MM, Carskadon MA, Guilleminault C, et al. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 2004; 27(7): 1238–9Google Scholar
  6. 6.
    Prinz PN, Vitello MV, Raskind MA, et al. Geriatric sleep disorders and aging. N Engl J Med 1990; 323(8): 520–6PubMedCrossRefGoogle Scholar
  7. 7.
    Folks DG, Fuller WC. Anxiety disorders and insomnia in geriatric patients. Psychiatr Clin North Am 1997; 20: 137–64PubMedCrossRefGoogle Scholar
  8. 8.
    Wooten V. Sleep disorders in geriatric patients. Clin Geriatr Med 1992; 8(2): 427–39PubMedGoogle Scholar
  9. 9.
    Ancoli-Israel S. Insomnia in the elderly: a review for the primary care practitioner. Sleep 2000; 23(2): S23–30PubMedGoogle Scholar
  10. 10.
    Fitzpatrick MF, Engleman H, Whyte KF, et al. Morbidity in nocturnal asthma: sleep quality and daytime cognitive performance. Thorax 1991; 46: 569–73PubMedCrossRefGoogle Scholar
  11. 11.
    Janson C, Gislason T, Boman G, et al. Sleep disturbances in patients with asthma. Respir Med 1990; 84: 37–42PubMedCrossRefGoogle Scholar
  12. 12.
    Asplund R. Sleep and cardiac disease among the elderly. J Intern Med 1994; 236: 65–71PubMedCrossRefGoogle Scholar
  13. 13.
    Woodward M. Insomnia in the elderly. Aust Fam Physician 1999; 28(7): 653–7PubMedGoogle Scholar
  14. 14.
    Lees AJ, Blackburn NA, Campbell VL. The nighttime problems of Parkinson’s disease. Clin Neuropharmacol 1988; 11: 512–9PubMedCrossRefGoogle Scholar
  15. 15.
    Nausieda PA, Weiner WJ, Kaplan LR, et al. Sleep disruption in the course of chronic levodopa therapy; an early feature of levodopa psychosis. Clin Neuropharmacol 1982; 5(2): 183–94PubMedCrossRefGoogle Scholar
  16. 16.
    Partinen M. Sleep disorder related to Parkinson’s disease. J Neurol 1997; 244(1): S3–6PubMedCrossRefGoogle Scholar
  17. 17.
    Mohsenin V, Valor R. Sleep apnea in patients with hemispheric stroke. Arch Phys Med Rehabil 1995; 76: 71–6PubMedCrossRefGoogle Scholar
  18. 18.
    Ancoli-Israel S. All I want is a good night’s sleep. Chicago (IL): Mosby-Year Book Inc., 1996Google Scholar
  19. 19.
    Brower KJ. Insomnia, alcoholism, and relapse. Sleep Med Rev 2003; 7(6): 523–39PubMedCrossRefGoogle Scholar
  20. 20.
    Vitiello MV. Sleep, alcohol, and alcohol abuse. Addict Biol 1997; 2: 151–8CrossRefGoogle Scholar
  21. 21.
    Ancoli-Israel S. Epidemiology of sleep disorders. In: Roth T, Roehrs TA, editors. Clinics in geriatric medicine. Philadelphia (PA): WB Saunders, 1989: 347–62Google Scholar
  22. 22.
    Ancoli-Israel S, Kripke DF, Klauber MR, et al. Sleep disordered breathing in community-dwelling elderly. Sleep 1991; 14: 486–95PubMedGoogle Scholar
  23. 23.
    Ancoli-Israel S, Kripke DF, Klauber MR, et al. Periodic limb movements in sleep in community-dwelling elderly. Sleep 1991; 14: 496–500PubMedGoogle Scholar
  24. 24.
    Mayeux R, Sano M. Drug therapy: treatment of Alzheimer’s disease. N Engl J Med 1999; 341(22): 1670–9PubMedCrossRefGoogle Scholar
  25. 25.
    Vitello MV, Bliwise DL, Prinz PN. Sleep in Alzheimer’s disease and the sundown syndrome. Neurology 1992; 42(6): 83–94Google Scholar
  26. 26.
    Little JT, Satlin A, Sunderland T, et al. Sundown syndrome in severely demented patients with probable Alzheimer’s disease. J Geriatr Psychiatry Neurol 1995; 8: 103–6PubMedGoogle Scholar
  27. 27.
    Volicer L, Harper DG, Maning BC, et al. Sundowning and circadian rhythms in Alzheimer’s disease. Am J Psychiatry 2001; 158(5): 704–11PubMedCrossRefGoogle Scholar
  28. 28.
    Stopa EG, Volicer L, Kuo-Leblanc V, et al. Pathological examination of the human suprachiasmatic nucleus in severe dementia. J Neuropathol Exp Neurol 1999; 58: 29–39PubMedCrossRefGoogle Scholar
  29. 29.
    Chokroverty S. Sleep and degenerative neurologic disorder. Neurol Clin 1996; 14: 807–26PubMedCrossRefGoogle Scholar
  30. 30.
    Ancoli-Israel S, Klauber MR, Butters N, et al. Dementia in institutionalized elderly: relation to sleep apnea. J Am Geriatr Soc 1991; 39(3): 258–63PubMedGoogle Scholar
  31. 31.
    Gehrman PR, Martin JL, Shochat T, et al. Sleep-disordered breathing and agitation in institutionalized adults with Alzheimer disease. Am J Geriatr Psychiatry 2003; 11(4): 426–33PubMedGoogle Scholar
  32. 32.
    Pollak CP, Perlick D. Sleep problems and institutionalization of the elderly. J Geriatr Psychiatry Neurol 1991; 4: 204–10PubMedCrossRefGoogle Scholar
  33. 33.
    Schnelle JF, Ouslander JG, Simmons SF, et al. The nighttime environment, incontinence care, and sleep disruption in nursing homes. J Am Geriatr Soc 1993; 41: 910–4PubMedGoogle Scholar
  34. 34.
    Alessi CA, Schelle JF, McRae PG, et al. Does physical activity improve sleep in impaired nursing home residents? J Am Geriatr Soc 1995; 43: 1098–102PubMedGoogle Scholar
  35. 35.
    Ancoli-Israel S, Parker L, Sinaee R, et al. Sleep fragmentation in residents from a nursing home. J Gerontol 1989; 44: M18–21PubMedCrossRefGoogle Scholar
  36. 36.
    Bliwise DL, Bevier WC, Bliwise NG, et al. Systematic 24-hour behavioral observations of sleep and wakefulness in a skilled-care nursing facility. Psychol Aging 1990; 5: 16–24PubMedCrossRefGoogle Scholar
  37. 37.
    Pat-Horenczyk R, Klauber MR, Shochat T, et al. Hourly profiles of sleep and wakefulness in severely vesus mild-moderate demented nursing home patients. Aging (Milano) 1998; 10(4): 308–15Google Scholar
  38. 38.
    Middlekoop HAM, Kerkhof GA, Smilde-Van Den Doel DA, et al. Sleep and ageing: the effect of institutionalization on subjective and objective characteristics of sleep. Age Ageing 1994; 23: 411–7CrossRefGoogle Scholar
  39. 39.
    Cohen D, Eisdorfer C, Prinz P, et al. A. Sleep disturbances in the institutionalized aged. J Am Geriatr Soc 1983; 31: 79–82PubMedGoogle Scholar
  40. 40.
    Cruise PA, Schnelle JF, Alessi CA, et al. The nighttime environment and incontinence care practices in nursing homes. J Am Geriatr Soc 1998; 46: 181–6PubMedGoogle Scholar
  41. 41.
    Schnelle JF, Cruise PA, Alessi CA, et al. Sleep hygiene in physically dependent nursing home residents: behavioral and environmental intervention implications. Sleep 1998; 21: 515–23PubMedGoogle Scholar
  42. 42.
    Ancoli-Israel S, Kripke DF. Now I lay me down to sleep: the problem of sleep fragmentation in the elderly and demented residents of nursing homes. Bull Clin Neurosci 1989; 54: 127–32Google Scholar
  43. 43.
    Ancoli-Israel S, Jones DW, Hanger MA, et al. Sleep in the nursing home. In: Kuna ST, Suratt PM, Remmers JE, editors. Sleep and respiration in ageing adults. New York: Elsevier Press, 1991: 77–84Google Scholar
  44. 44.
    Ancoli-Israel S, Klauber MR, Jones DW, et al. Variations in circadian rhythms of activity, sleep and light exposure related to dementia in nursing-home patients. Sleep 1997; 20(1): 18–23PubMedGoogle Scholar
  45. 45.
    Campbell SS, Kripke DF, Gillin JC, et al. Exposure to light in healthy elderly subjects and Alzheimer’s patients. Physiol Behav 1988; 42: 141–4PubMedCrossRefGoogle Scholar
  46. 46.
    Shochat T, Martin J, Marier M, et al. Illumination levels in nursing home patients: effects on sleep and activity rhythms. J Sleep Res 2000; 9: 373–9PubMedCrossRefGoogle Scholar
  47. 47.
    Rovner BW, German PS, Broadhead J, et al. The prevalence and management of dementia and other psychiatric disorders in nursing homes. Int Psychogeriatr 1990; 2(1): 13–24PubMedCrossRefGoogle Scholar
  48. 48.
    Brodaty H, Draper B, Saab D, et al. Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. Int J Geriatr Psychiatry 2001; 16(5): 504–12PubMedCrossRefGoogle Scholar
  49. 49.
    Katz IR, Lesher E, Kleban M, et al. Clinical features of depression in the nursing home. Int Psychogeriatr 1989; 1(1): 5–15PubMedCrossRefGoogle Scholar
  50. 50.
    Ames D. Epidemiological studies of depression among the elderly in residential and nursing homes. Int J Geriatr Psychiatry 1991; 6(6): 347–54CrossRefGoogle Scholar
  51. 51.
    Payne JL, Sheppard JM, Steinberg M, et al. Incidence, prevalence and outcomes of depression in residents of a long-term care facility with dementia. Int J Geriatr Psychiatry 2002; 17(3): 247–53PubMedCrossRefGoogle Scholar
  52. 52.
    Conn DK, Ferguson I, Mandelman K, et al. Psychotropic drug utilization in long-term care facilities for the elderly in Ontario, Canada. Int Psychogeriatr 1999; 11: 223–33PubMedCrossRefGoogle Scholar
  53. 53.
    Nolan L, O’Malley K. The need for a more rational approach to drug prescribing for elderly people in nursing homes. Age Ageing 1989; 18: 52–6PubMedCrossRefGoogle Scholar
  54. 54.
    Tyberg J, Gulmann NC. Use of psychopharmaceuticals in municipal nursing homes: a national survey. Ugeskr Laeger 1992; 154: 3126–9Google Scholar
  55. 55.
    Snowdon J, Vaughan R, Miller R, et al. Psychotropic drug use in Sydney nursing homes. Med J Aust 1995; 163: 70–2PubMedGoogle Scholar
  56. 56.
    Wancata J, Benda N, Meise U, et al. Psychotropic drug intake in residents newly admitted to nursing homes. Pharmacology 1997; 134: 115–20Google Scholar
  57. 57.
    Borson S, Doane K. The impact of OBRA-87 on psychotropic drug prescribing in skilled nursing facilities. Psychiatr Serv 1997; 48: 1289–96PubMedGoogle Scholar
  58. 58.
    Tobias DE, Pulliam CC. General and psychotherapeutic medication use in 878 nursing facilities: a 1997 national survey. Consult Pharm 1997; 12: 1401–8Google Scholar
  59. 59.
    Schmidt I, Claesson CB, Westerholm B, et al. The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish nursing homes. J Am Geriatr Soc 1998; 46: 77–82PubMedGoogle Scholar
  60. 60.
    Hosia-Randell H, Pitkälä K. Use of psychotropic drugs in elderly nursing home residents with and without dementia in Helsinki, Finland. Drugs Aging 2005; 22(9): 793–800PubMedCrossRefGoogle Scholar
  61. 61.
    Snowdon J. Mental health in nursing homes: perspectives on the use of medication. Drugs Aging 1993; 3: 122–30PubMedCrossRefGoogle Scholar
  62. 62.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990; 47: 533–43PubMedGoogle Scholar
  63. 63.
    Avorn J, Gurwitz JH. Drugs in the nursing home. Ann Intern Med 1995; 123: 195–204PubMedGoogle Scholar
  64. 64.
    Beers MH, Ouslander J, Rollinger I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 1991; 151: 1825–32PubMedCrossRefGoogle Scholar
  65. 65.
    Beers MH, Fingold SF, Ouslander JG, et al. Characteristics and quality of prescribing by doctors practicing in nursing homes. J Am Geriatr Soc 1993; 41: 802–7PubMedGoogle Scholar
  66. 66.
    Conn DK. Optimizing the use of psychotropic medications. In: Conn DK, Herrmann N, Kaye A, et al., editors. Practical psychiatry in the long term care facility: a handbook for staff. Toronto (ON): Hogrefe and Huber, 2001Google Scholar
  67. 67.
    Omnibus Budget Reconciliation Act of 1987: subtitle C. Nursing home reform: PL100-203. Washington, DC: National Coalition for Nursing Home Reform, 1987Google Scholar
  68. 68.
    Shorr RI, Gought RL, Ray WA. Changes in antipsychotic drug use in nursing home during implementation of the OBRA-87 regulation. JAMA 1994; 271: 358–63PubMedCrossRefGoogle Scholar
  69. 69.
    Lantz M, Giambanco V, Buchalter EN. A ten-year review of the effect of OBRA-87 on psychotropic prescribing practices in an academic nursing home. Psychiatr Serv 1996; 47: 951–5PubMedGoogle Scholar
  70. 70.
    Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 2005; 294(15): 1934–43PubMedCrossRefGoogle Scholar
  71. 71.
    Cramer GW, Chaponis RJ, Bauwens S, et al. Evaluation of sleep disorders in nursing facilities. Consult Pharm 1999; 14: 545–56.Google Scholar
  72. 72.
    Craig D, Passmore AP, Fullerton KJ, et al. Factors influencing prescription of CNS medications in different elderly populations. Pharmacoepidemiol Drug Saf 2003: 12: 383–7PubMedCrossRefGoogle Scholar
  73. 73.
    Eide E, Schjott J. Assessing the effects of an intervention by a pharmacist on prescribing and administration of hypnotics in nursing homes. Pharm World Sci 2001; 23(6): 227–31PubMedCrossRefGoogle Scholar
  74. 74.
    Monane M, Glynn RJ, Avorn J. The impact of sedative-hypnotic use on sleep symptoms in elderly nursing home residents. Clin Pharmacol Ther 1996; 59(1): 83–92PubMedCrossRefGoogle Scholar
  75. 75.
    Seppala M, Rajala T, Sourander L. Subjective evaluation of sleep and the use of hypnotics in nursing homes. Aging (Milano) 1993; 5(3): 199–205Google Scholar
  76. 76.
    Clapin-French E. Sleep patterns of aged persons in long-term care facilities. J Adv Nurs 1986; 11(1): 57–66PubMedCrossRefGoogle Scholar
  77. 77.
    Holmquist IB, Svenssou B, Hoglund P. Psychotropic drugs in nursing and old age homes: relationships between needs of care and mental health status. Eur J Clin Pharmacol 2003; 59: 669–76PubMedCrossRefGoogle Scholar
  78. 78.
    Svarstad BL, Mount JK. Effects of residents’ depression, sleep, and demand for medication on benzodiazepine use in nursing homes. Psychiatr Serv 2002; 53(9): 1159–65PubMedCrossRefGoogle Scholar
  79. 79.
    Martin J, Shochat T, Ancoli-Israel S. Assessment and treatment of sleep disturbances in older adults. Clin Psychol Rev 2000; 20(6): 783–805PubMedCrossRefGoogle Scholar
  80. 80.
    Chesson Jr AL, Anderson WM, Littner M, et al. Practice parameters for the nonpharmacologic treatment of chronic insomnia: an American Academy of Sleep report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep 1999; 22(8): 1128–33PubMedGoogle Scholar
  81. 81.
    Alessi CA, Yoon EJ, Schnelle JF, et al. A randomized trial of a combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve? J Am Geriatr Soc 1999; 47(7): 784–91PubMedGoogle Scholar
  82. 82.
    Alessi CA, Martin JL, Webber AP, et al. Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents. J Am Geriatr Soc 2005; 53(5): 803–10PubMedCrossRefGoogle Scholar
  83. 83.
    Ancoli-Israel S, Gehrman P, Martin JL, et al. Increased light exposure consolidates sleep and strengthens circadian rhythms in severe Alzheimer’s disease patients. Behav Sleep Med 2003; 1(1): 22–36PubMedCrossRefGoogle Scholar
  84. 84.
    Ancoli-Israel S, Martin JL, Kripke DF, et al. Effect of light treatment on sleep and circadian rhythms in demented nursing home patients. J Am Geriatr Soc 2002; 50(2): 282–9PubMedCrossRefGoogle Scholar
  85. 85.
    Satlin A, Volicer L, Ross V, et al. Bright light treatment of behavioral and sleep disturbances in patients with Alzheimer’s disease. Am J Psychiatry 1992; 149(8): 1028–32PubMedGoogle Scholar
  86. 86.
    Morin CM, Colecchi C, Stone J, et al. Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA 1999; 281(11): 991–9PubMedCrossRefGoogle Scholar
  87. 87.
    Holbrook AM, Crowther R, Lotter A, et al. Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ 2000; 162(2): 225–33PubMedGoogle Scholar
  88. 88.
    Avidan AY, Fries BE, James ML, et al. Insomnia and hypnotic use, recorded in the minimum data set, as predictors of falls and hip fractures in Michigan nursing homes. J Am Geriatr Soc 2005; 53(6): 955–62PubMedCrossRefGoogle Scholar
  89. 89.
    Meuleman JR, Nelson RC, Clark Jr RL. Evaluation of temazepam and diphenhydramine as hypnotics in a nursing home population. Drug Intell Clin Pharm 1987; 21(9): 716–20PubMedGoogle Scholar
  90. 90.
    Agostini JV, Leo-Summers LS, Inouye SK. Cognitive and other adverse effects of diphenhydramine use in hospitalized older patients. Arch Intern Med 2001; 161: 2091–7PubMedCrossRefGoogle Scholar
  91. 91.
    McLeod PJ, Huang AR, Tamblyn RM, et al. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ 1997; 156(3): 385–91.PubMedGoogle Scholar
  92. 92.
    Ray WA, Thapa PB, Gideon P. Benzodiazepines and the risk of falls in nursing home residents. J Am Geriatr Soc 2000; 48(6): 682–5PubMedGoogle Scholar
  93. 93.
    Landi F, Onder G, Cesari M, et al. Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study. J Gerontol A Biol Sci Med Sci 2005; 60(5): 622–6PubMedCrossRefGoogle Scholar
  94. 94.
    National Institutes of Health. National Institutes of Health State of the Science Conference statement on manifestations and management of chronic insomnia in adults, 2005 Jun 13–15. Sleep 2005; 28(9): 1049–57Google Scholar
  95. 95.
    Swift CG, Swift MR, Hamley J, et al. Side-effect ‘tolerance’ in elderly long-term recipients of benzodiazepine hypnotics. Age Ageing 1984; 13(6): 335–43PubMedCrossRefGoogle Scholar
  96. 96.
    Rothschild AJ. Disinhibition, amnestic reactions, and other adverse reactions secondary to triazolam: a review of the literature. J Clin Psychiatry 1992; 53 Suppl.: 69–79PubMedGoogle Scholar
  97. 97.
    Jenner P, Pratt JA, Marsden CD. Mechanism of action of clonazepam in myoclonus in relation to effects on GABA and 5-HT. Adv Neurol 1986; 43: 629–43PubMedGoogle Scholar
  98. 98.
    Mitler MM, Browman CP, Menn SJ, et al. Nocturnal myoclonus: treatment efficacy of clonazepam and temazepam. Sleep 1986; 9(3): 385–92PubMedGoogle Scholar
  99. 99.
    Fulda S, Wetter TC. Dopamine agonists for the treatment of restless legs syndrome. Expert Opin Pharmacother 2005; 6(15): 2655–66PubMedCrossRefGoogle Scholar
  100. 100.
    Drover DR. Comparative pharmacokinetics and pharmacodynamics of short-acting hypnosedatives: zaleplon, zolpidem and zopiclone. Clin Pharmacokinet 2004; 43(4): 227–38PubMedCrossRefGoogle Scholar
  101. 101.
    Heydorn WE. Zaleplon: a review of a novel sedative hypnotic used in the treatment of insomnia. Expert Opin Investig Drugs 2000; 9(4): 841–58PubMedCrossRefGoogle Scholar
  102. 102.
    Ancoli-Israel S, Walsh JK, Mangano RM, et al. Zaleplon, a novel nonbenzodiazepine hypnotic, effectively treats insomnia in elderly patients without causing rebound effects. Prim Care Companion J Clin Psychiatry 1999; 1(4): 114–20PubMedCrossRefGoogle Scholar
  103. 103.
    Ancoli-Israel S, Richardson GS, Mangano RM, et al. Long-term use of sedative hypnotics in older patients with insomnia. Sleep Med 2005; 6(2): 107–13PubMedCrossRefGoogle Scholar
  104. 104.
    Terzano MG, Rossi M, Palomba V, et al. New drugs for insomnia: comparative tolerability of zopiclone, zolpidem and zaleplon. Drug Saf 2003; 26(4): 261–82PubMedCrossRefGoogle Scholar
  105. 105.
    Barbera J, Shapiro C. Benefit-risk assessment of zaleplon in the treatment of insomnia. Drug Saf 2005; 28(4): 301–18PubMedCrossRefGoogle Scholar
  106. 106.
    Scharf MB, Mayleben DW, Kaffeman M, et al. Dose response effects of zolpidem in normal geriatric subjects. J Clin Psychiatry 1991; 52(2): 77–83PubMedGoogle Scholar
  107. 107.
    Roger M, Attali P, Coquelin JP. Multicenter, double-blind, controlled comparison of zolpidem and triazolam in elderly patients with insomnia. Clin Ther 1993; 15(1): 127–36PubMedGoogle Scholar
  108. 108.
    Hemmeter U, Muller M, Bischof R, et al. Effect of zopiclone and temazepam on sleep EEG parameters, psychomotor and memory functions in healthy elderly volunteers. Psychopharmacology (Berl) 2000; 147(4): 384–96CrossRefGoogle Scholar
  109. 109.
    Copinschi G, Akseki E, Moreno-Reyes R, et al. Effects of bedtime administration of zolpidem on circadian and sleep-related hormonal profiles in normal women. Sleep 1995; 18(6): 417–24PubMedGoogle Scholar
  110. 110.
    Montplaisir J, Hawa R, Moller H, et al. Zopiclone and zaleplon vs benzodiazepines in the treatment of insomnia: Canadian consensus statement. Hum Psychopharmacol 2003; 18(1): 29–38PubMedCrossRefGoogle Scholar
  111. 111.
    Tamminen T, Hansen PP. Chronic administration of zopiclone and nitrazepam in the treatment of insomnia. Sleep 1987; 10Suppl. 1: 63–72PubMedGoogle Scholar
  112. 112.
    Pecknold J, Wilson R, le Morvan P. Long term efficacy and withdrawal of zopiclone: a sleep laboratory study. Int Clin Psychopharmacol 1990; 5Suppl. 2: 57–67PubMedGoogle Scholar
  113. 113.
    Wortelboer U, Cohrs S, Rodenbeck A, et al. Tolerability of hypnosedatives in older patients. Drugs Aging 2002; 19(7): 529–39PubMedCrossRefGoogle Scholar
  114. 114.
    Allain H, Bentue-Ferrer D, Polard E, et al. Postural instability and consequent falls and hip fractures associated with use of hypnotics in the elderly. Drugs Aging 2005; 22(9): 749–65PubMedCrossRefGoogle Scholar
  115. 115.
    Melton ST, Wood JM, Kirkwood CK. Eszopiclone for insomnia. Ann Pharmacother 2005; 39(10): 1659–66PubMedCrossRefGoogle Scholar
  116. 116.
    Scharf M, Erman M, Rosenberg R, et al. A 2-week efficacy and safety study of eszopiclone in elderly patients with primary insomnia. Sleep 2005; 28(6): 720–7PubMedGoogle Scholar
  117. 117.
    Krystal AD, Walsh JK, Laska E, et al. Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. Sleep 2003; 26: 793–9PubMedGoogle Scholar
  118. 118.
    Sadavoy J. Psychotropic drugs and the elderly: fast facts. New York: WW Norton and Company, 2004Google Scholar
  119. 119.
    Roth T, Stubbs C, Walsh JK. Ramelteon (TAK-375), a selective MT1/MT2-receptor agonist, reduces latency to persistent sleep in a model of transient insomnia related to a novel sleep environment. Sleep 2005; 28(3): 303–7PubMedGoogle Scholar
  120. 120.
    Erman M, Sciden D, Zammit G, et al. An efficacy, safety, and dose-response study of ramelteon in patients with chronic primary insomnia. Sleep Med 2006; 7(1): 17–24PubMedCrossRefGoogle Scholar
  121. 121.
    Tobias DE, Sey M. General and psychotherapeutic medication use in 328 facilities: a year 2000 national survey. Consult Pharm 2001; 16(1): 54–64Google Scholar
  122. 122.
    Kunik ME, Orengo CA, Molinari V, et al. Trazodone for sleep and agitation in a geropsychiatry inpatient unit. Nurs Home Med 1996; 4: 255–9Google Scholar
  123. 123.
    Mendelson WB. A review of the evidence for the efficacy and safety of trazodone in insomnia. J Clin Psychiatry 2005; 66(4): 469–76PubMedCrossRefGoogle Scholar
  124. 124.
    Winokur A, Sateia MJ, Hayes JB, et al. Acute effects of mirtazapine on sleep continuity and sleep architecture in depressed patients: a pilot study. Biol Psychiatry 2000 Jul 1; 48(1): 75–8PubMedCrossRefGoogle Scholar
  125. 125.
    Schittecatte M, Dumont F, Machowski R, et al. Effects of mirtazapine on sleep polygraphic variables in major depression. Neuropsychobiology 2002; 46(4): 197–201PubMedCrossRefGoogle Scholar
  126. 126.
    Roose SP, Nelson JC, Salzman C. Open-label study of mirtazapine orally disintegrating tablets in depressed patients in the nursing home. Curr Med Res Opin 2003; 19(8): 737–46PubMedCrossRefGoogle Scholar
  127. 127.
    Cohen-Mansfield J, Werner P, Freedman L. Sleep and agitation in agitated nursing home residents: an observational study. Sleep 1995; 18(8): 674–80PubMedGoogle Scholar

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© Adis Data Information BV 2006

Authors and Affiliations

  1. 1.Department of PsychiatryBaycrest Geriatric Health Care SystemTorontoCanada
  2. 2.Department of PsychiatryUniversity of TorontoTorontoCanada

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