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Pharmacotherapy of Insomnia in Older Adults

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Optimizing Pharmacotherapy in Older Patients

Part of the book series: Practical Issues in Geriatrics ((PIG))

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Abstract

Independently from age-related changes, sleep problems affect 10–15% of the general population and increase with older age as well. Insomnia is the most prevalent and the most researched sleep disturbance. In this chapter, the pharmacological treatment options have been discussed.

Pharmacological treatments are categorised as benzodiazepines (BZDs) and non-benzodiazepine receptor agonists (so-called Z-drugs), as the most commonly used drug classes, and alternatives including antidepressants, melatonin receptor agonists and orexin receptor antagonists. BZDs and Z-drugs are effective for short-term treatment of insomnia. Older adults, with a higher risk of side effects, need tailored prescribing which also includes deprescribing. Different antidepressants, including trazodone, tricyclic antidepressants (doxepin), and serotonergic antidepressant (mirtazapine), have sedating properties and are often used for the treatment of insomnia.

However, despite the fact that these alternatives have been shown to be more effective than placebo at bettering short-term sleep outcomes, the size of effect is variable, and the overall estimation of benefit-to-risk ratio is low. The potential benefits of pharmacotherapy on sleep quality and daytime function in older adults should always be balanced against the risk of side effects and physical and psychological dependence with long-term use.

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References

  1. Conn D, Madan R. Use of sleep-promoting medications in nursing home residents: risks versus benefits. Drugs Aging. 2006;23:271–87.

    PubMed  Google Scholar 

  2. Wolkove N, Elkholy O, Baltzan M, Palayew M. Sleep and aging: 1. Sleep disorders commonly found in older people. Can Med Assoc J. 2007;176:1299–304.

    Google Scholar 

  3. Patel D, Steinberg J, Patel P. Insomnia in the elderly: a review. J Clin Sleep Med. 2018;14:1017–24.

    PubMed  PubMed Central  Google Scholar 

  4. Crowley K. Sleep and sleep disorders in older adults. Neuropsychol Rev. 2011;21:41–53.

    PubMed  Google Scholar 

  5. Ohayon M. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97–111.

    PubMed  Google Scholar 

  6. Hillman D, Murphy A, Pezzullo L. The economic cost of sleep disorders. Sleep. 2006;29:299–305.

    PubMed  Google Scholar 

  7. Roth T, Coulouvrat C, Hajak G, Lakoma M, Sampson N, Shahly V, Shillington A, Stephenson J, Walsh J, Kessler R. Prevalence and perceived health associated with insomnia based on DSM-IV-TR; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition criteria: results from the America Insomnia Survey. Biol Psychiatry. 2011;69:592–600.

    PubMed  Google Scholar 

  8. Foley D, Monjan A, Simonsick E, Wallace R, Blazer D. Incidence and remission of insomnia among elderly adults: an epidemiologic study of 6,800 persons over three years. Sleep. 1999;22(Suppl 2):S366–72.

    PubMed  Google Scholar 

  9. Gureje O, Oladeji B, Abiona T, Lebowitz M. The natural history of insomnia in the Ibadan study of ageing. Sleep. 2011;34:965–73.

    PubMed  PubMed Central  Google Scholar 

  10. Naylor E, Penev P, Orbeta L, Janssen I, Ortiz R, Colecchia E, Keng M, Finkel S, Zee P. Daily social and physical activity increases slow wave sleep and daytime neuropsychological performance in the elderly. Sleep. 2000;23:87–95.

    CAS  PubMed  Google Scholar 

  11. McCurry S, Logsdon R, Teri L, Vitiello M. Evidence-based psychological treatments for insomnia in older adults. Psychol Aging. 2007;22:18–27.

    PubMed  Google Scholar 

  12. Smith M, Perlis M, Park A, Smith M, Pennington J, Giles D, Buysse D. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry. 2002;159:5–11.

    PubMed  Google Scholar 

  13. Sateia M, Buysse D, Krystal A, Neubauer D, Heald J. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13:307–49.

    PubMed  PubMed Central  Google Scholar 

  14. Petrovic M, Mariman A, Warie H, Afschrift M, Pevernagie D. Is there a rationale for prescription of benzodiazepines in the elderly? Review of the literature. Acta Clin Belg. 2003;58:27–36.

    CAS  PubMed  Google Scholar 

  15. Hobbs W, Rail T, Verdoom T. Hypnotics and sedatives; ethanol. In: Hardman JG, Gilman AG, Limbird LE, editors. Goodman & Gilman’s the pharmacological basis of therapeutics. New York: Me Graw-Hill Health Profession Division; 1996. p. 361–97.

    Google Scholar 

  16. Heydom W. Zaleplon—a review of a novel sedative hypnotic used in the treatment of insomnia. Exp Opin Invest Drugs. 2000;9:841–58.

    Google Scholar 

  17. Stahl S. Anxiolytic and sedative-hypnotics. In: Stahl SM, editor. Essential psychopharmacology. Cambridge: Cambridge University Press; 2000. p. 297–333.

    Google Scholar 

  18. Kirkwood CK. Management of insomnia. J Am Pharm Assoc. 1999;39:688–96.

    CAS  Google Scholar 

  19. Roth T, Roehrs TA. Issues in the use of benzodiazepine therapy. J Clin Psychiatry 1992; 53 (Suppl 6): 14–18.

    PubMed  Google Scholar 

  20. Ashton H. Guidelines for rational use of benzodiazepines -when and what to use. Drugs. 1994;48:25–40.

    CAS  PubMed  Google Scholar 

  21. Hammerlein A, Derendorf H, Lowenthal D. Pharmacokinetic and pharmacodynamic changes in the elderly. Clin Pharmacokinet. 1998;35:49–64.

    CAS  PubMed  Google Scholar 

  22. Breiner D. Clinical pharmacokinetics of hypnotics. Clin Pharmacokinet. 1997;2:93–109.

    Google Scholar 

  23. Buysse D, Reynolds C. Pharmacologic treatment. In: Lichstein KL, Morin CM, editors. Treatment of late-life insomnia. Thousand Oaks: Sage Publications; 2000. p. 231–67.

    Google Scholar 

  24. Greenblatt D, Harmatz J, Shader R. Clinical pharmacokinetics of anxiolytics and hypnotics in the elderly: therapeutic considerations. Clin Pharmacokinet. 1991;21:165–77.

    CAS  PubMed  Google Scholar 

  25. Ozdemir V, Fourie J, Busto U, Naranjo A. Pharmacokinetic changes in the elderly. Clin Pharmacokinet. 1996;31:372–85.

    CAS  PubMed  Google Scholar 

  26. Feely J, Coakley D. Altered pharmacodynamics in the elderly. Clin Geriatr Med. 1990;6:269–83.

    CAS  PubMed  Google Scholar 

  27. Turner N, Scarpace PJ, Lowenthal DT. Geriatric pharmacology: basic and clinical consideration. Annu Rev Pharmacol Toxicol. 1992;32:271–302.

    Google Scholar 

  28. Foy A, O’Connell D, Henry D, Kelly J, Cocking S, Halliday J. Benzodiazepine use as a cause of cognitive impairment in elderly hospital inpatients. J Gerontol Med Sci. 1995;50A:M99–M106.

    Google Scholar 

  29. Herings R, Strieker B, de Boer A, Bakker A, Sturmans F. Benzodiazepines and the risk of falling leading to femur fractures. Arch Intern Med. 1995;155:1801–7.

    CAS  PubMed  Google Scholar 

  30. Swift C, Swift M, Hamley J, Stevenson I, Crooks J. Side-effect ‘tolerance’ in elderly long-term recipients of benzodiazepine hypnotics. Age Ageing. 1987;13:335–43.

    Google Scholar 

  31. Petursson H, Lader M. Benzodiazepine dependence. Br J Addiction. 1984;76:133–45.

    Google Scholar 

  32. Schneider-Helmert D. Why low dose benzodiazepine-dependent insomniacs can’t escape their sleeping pills. Acta Psychiatr Scand. 1988;78:706–11.

    CAS  PubMed  Google Scholar 

  33. Grad R. Benzodiazepines for insomnia in community dwelling elderly: a review of benefit and risk. J Fam Pract. 1995;41:473–81.

    CAS  PubMed  Google Scholar 

  34. Wheatley D. Effects of drugs on sleep. In: Wheatley D, editor. Psychopharmacology of sleep. New York: Raven Press; 1981. p. 153–76.

    Google Scholar 

  35. Tyrer P. Choices of treatment in anxiety. In: Tyrer P, editor. Psychopharmacology of anxiety. Oxford: Oxford Medical Publications; 1989. p. 255–82.

    Google Scholar 

  36. Olivier H, Fitz-Gerald MJ, Babiak B. Benzodiazepines revisited. J La State Med Soc. 1988;150:483–5.

    Google Scholar 

  37. Brodie M. Status epilepticus in adults. BMJ. 1990;336:551–2.

    CAS  Google Scholar 

  38. Herrington R. The use of benzodiazepines in neuropsychiatry. In: Hindmarch I, Bauamont G, Brandon S, Leonard B, editors. Benzodiazepines: current concepts. Chichester: John Wiley & Sons Ltd; 1990. p. 95–110.

    Google Scholar 

  39. Buysse D. Drugs affecting sleep, sleepiness and performance. In: Monk TH, editor. Sleep, sleepiness and performance. London: John Wiley & Sons; 1991. p. 249–306.

    Google Scholar 

  40. Morgan K. Hypnotics in the elderly: what cause for concern? Drugs. 1990;40:688–96.

    CAS  PubMed  Google Scholar 

  41. Mangoni A, Jackson S. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57:6–14.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Greenblatt D, Divoll HJ, MacLaughlin D, Shader R. Kinetics and clinical effects of flurazepam in young and elderly noninsomniacs. Clin Pharmacol Ther. 1981;30:475–86.

    CAS  PubMed  Google Scholar 

  43. Swift C, Ewen J, Clarke P, Stevenson I. Responsiveness to oral diazepam in the elderly: relationship to total and free plasma concentrations. Br J Clin Pharmacol. 1985;20:111–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Berry S, Lee Y, Cai S, Dore D. Nonbenzodiazepine sleep medication use and hip fractures in nursing home residents. JAMA Intern Med. 2013;173:754–61.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Leipzig R, Cumming R, Tinetti M. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc [Proceedings Paper]. 1999;47:30–9.

    CAS  PubMed  Google Scholar 

  46. Woolcott J, Richardson K, Wiens M, Patel B, Marin J, Khan K, Marra C. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169:1952–60.

    PubMed  Google Scholar 

  47. Sterke C, Verhagen A, van Beeck E, van der Cammen T. The influence of drug use on fall incidents among nursing home residents: a systematic review. Int Psychogeriatr. 2008;20:890–910.

    PubMed  Google Scholar 

  48. Lucki I, Rickels K, Geller A. Chronic use of benzodiazepines and psychomotor and cognitive test performance. Psychopharmacol. 1986;88:426–33.

    CAS  Google Scholar 

  49. Hajak G, Clarenbach P, Fischer W, Rodenbeck A, Bandelow B, Broocks A, Ruther E. Rebound insomnia after hypnotic withdrawal in insomniac outpatients. Eur Arch Psychiatry Clin Neurosci. 1998;248:148–56.

    CAS  PubMed  Google Scholar 

  50. Ancoli-Israel S. Insomnia in the elderly: a review for the primary care practitioner. Sleep. 2000;23(Suppl 1):S23–9.

    PubMed  Google Scholar 

  51. Mendels J. Criteria for selection of appropriate benzodiazepine hypnotic therapy. J Clin Psychiatry. 1991;52:42–6.

    PubMed  Google Scholar 

  52. Wang S, Chen W, Tang S, Lin H, Peng C, Chu H, Kao C. Benzodiazepines associated with acute respiratory failure in patients with obstructive sleep apnea. Front Pharmacol. 2019;9:1513.

    PubMed  PubMed Central  Google Scholar 

  53. Riemann D, Perlis M. The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Med Rev. 2009;13:205–14.

    PubMed  Google Scholar 

  54. Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, Klassen T, Witmans M. The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs. J Gen Intern Med. 2007;22:1335–50.

    PubMed  PubMed Central  Google Scholar 

  55. Holbrook AM, Crowther R, Lotter A, Cheng C, King D. Meta-analysis of benzodiazepine use in the treatment of insomnia. Can Med Assoc J. 2000;162:225–33.

    CAS  Google Scholar 

  56. Huedo-Medina T, Kirsch I, Middlemass J, Klonizakis M, Siriwardena N. Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. Br Med J. 2012;345:e8343.

    Google Scholar 

  57. Nowell P, Mazumdar S, Buysse D, Dew M, Reynolds C, Kupfer D. Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy. J Am Med Assoc. 1997;278:2170–7.

    CAS  Google Scholar 

  58. Glass J, Lanctot K, Herrmann N, Sproule B, Busto U. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. Br Med J. 2005;331:1169.

    Google Scholar 

  59. Mattila T, Stoyanova V, Elferink A, Gispen-de Wied C, de Boer A, Wohlfarth T. Insomnia medication: do published studies reflect the complete picture of efficacy and safety? Eur Neuropsychopharmacol. 2011;21:500–7.

    CAS  PubMed  Google Scholar 

  60. McCall W, D’Agostino R, Dunn A. A meta-analysis of sleep changes associated with placebo in hypnotic clinical trials. Sleep Med. 2003;4:57–62.

    PubMed  Google Scholar 

  61. Belanger L, Vallieres A, Ivers H, Moreau V, Lavigne G, Morin C. Meta-analysis of sleep changes in control groups of insomnia treatment trials. J Sleep Res. 2007;16:77–84.

    PubMed  Google Scholar 

  62. Morin C, Colecchi C, Stone J, Sood R, Brink D. Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. J Am Med Assoc. 1999;281:991–9.

    CAS  Google Scholar 

  63. Krystal A, Walsh J, Laska E, Caron J, Amato D, Wessel T, Roth T. 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;26:793–9.

    PubMed  Google Scholar 

  64. Ancoli-Israel S, Richardson G, Mangano R, Jenkins L, Hall P, Jones W. Long-term use of sedative hypnotics in older patients with insomnia. Sleep Med. 2005;6:107–13.

    PubMed  Google Scholar 

  65. Ohayon M, Caulet M, Arbus L, Billard M, Coquerel A, Guieu J, Kullmann B, Loffont F, Lemoine P, Paty J, Pechadre J, Vecchierini M, Vespignani H. Are prescribed medications effective in the treatment of insomnia complaints? J Psychosom Res. 1999;47:359–68.

    CAS  PubMed  Google Scholar 

  66. Billioti de Gage S, Begaud B, Bazin F, Verdoux H, Dartigues J, Pérès K, Kurth T, Pariente A. Benzodiazepine use and risk of dementia: prospective population based study. Br Med J. 2012;345:e6231.

    Google Scholar 

  67. Englert S, Linden M. Differences in self-reported sleep complaints in elderly persons living in the community who do or do not take sleep medication. J Clin Psychiatry. 1998;59:137–44.

    CAS  PubMed  Google Scholar 

  68. Ostini R, Jackson C, Hegney D, Tett S. How is medication prescribing ceased? A systematic review. Med Care. 2011;49:24–36.

    PubMed  Google Scholar 

  69. Higgitt A, Lader M, Fonagy P. Clinical management of benzodiazepine dependence. Brit Med J. 1985;291:688–90.

    CAS  Google Scholar 

  70. Ashton H. Benzodiazepine withdrawal: outcome in 50 patients. Br J Addiction. 1987;82:665–71.

    CAS  Google Scholar 

  71. Holton A, Riley P, Tyrer P. Factors predicting long-term outcome after chronic benzodiazepine therapy. J Affect Disord. 1992;24:245–52.

    CAS  PubMed  Google Scholar 

  72. Roy-Byme P, Hommer D. Benzodiazepine withdrawal: overview and implications for the treatment of anxiety. Am J Med. 1988;84:1041–52.

    Google Scholar 

  73. Ancoli-Israel S. Sleep problems in older adults: putting myths to bed. Geriatrics. 1997;52:20–30.

    CAS  PubMed  Google Scholar 

  74. Schweizer F, Case W, Rickels K. Benzodiazepine dependence and withdrawal in elderly patients. Am J Psychiatry. 1989;146:529–31.

    CAS  PubMed  Google Scholar 

  75. Petrovic M, Pevemagie D, Van Den Noortgate N, Mariman A, Michielsen W, Afschrift M. A programme for short-term withdrawal from benzodiazepines in geriatric hospital inpatients: success rate and effect on sleep quality. Int J Geriatr Psychiatry. 1999;14:754–60.

    CAS  PubMed  Google Scholar 

  76. Reeve E, Ong M, Wu A, Jansen J, Petrovic M, Gnjidic D. A systematic review of interventions to deprescribe benzodiazepines and other hypnotics among older people. Eur J Clin Pharmacol. 2017;73:927–35.

    CAS  PubMed  Google Scholar 

  77. Lader M, Tylee A, Donoghue J. Withdrawing benzodiazepines in primary care. CNS Drugs. 2009;23:19–34.

    CAS  PubMed  Google Scholar 

  78. Morin C, Bastien C, Guay B, Radouco-Thomas M, Leblanc J, Vallières A. Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. Am J Psychiatry. 2004;161:332–42.

    PubMed  Google Scholar 

  79. Lichstein K, Nau S, Wilson N, Aguillard R, Lester K, Bush A, McCrae C. Psychological treatment of hypnotic-dependent insomnia in a primarily older adult sample. Behav Res Ther. 2013;51:787–96.

    PubMed  Google Scholar 

  80. Gould R, Coulson M, Patel N, Highton-Williamson E, Howard R. Interventions for reducing benzodiazepine use in older people: meta-analysis of randomised controlled trials. Br J Psychiatry. 2014;204:98–107.

    PubMed  Google Scholar 

  81. Roberts MS, Stokes JA, King MA, Lynne T, Purdie D, Glasziou P, Wilson D, McCarthy S, Brooks G, de Looze F, Del Mar C. Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. Br J Clin Pharmacol. 2001;51:257–65.

    CAS  PubMed  PubMed Central  Google Scholar 

  82. Forsetlund L, Eike MC, Gjerberg E, Vist G. Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials. BMC Geriatr. 2011;11:16.

    PubMed  PubMed Central  Google Scholar 

  83. Gilbert A, Owen N, Innes J, Sansom L. Trial of an intervention to reduce chronic benzodiazepine use among residents of aged-care accommodation. Aust NZ J Med. 1993;23:343–7.

    CAS  Google Scholar 

  84. Smith A, Tett S. Improving the use of benzodiazepines—is it possible? A non-systematic review of interventions tried in the last 20 years. BMC Health Serv Res. 2010;10:321.

    PubMed  PubMed Central  Google Scholar 

  85. Salzman C, Fisher J, Nobel K, Glassman R, Wolfson A, Kelley M. Cognitive improvement following benzodiazepine discontinuation in elderly nursing home residents. Int J Geriatr Psych. 1992;7:89–93.

    Google Scholar 

  86. Habraken H, Soenen K, Blondeel L, Van Elsen J, Bourda J, Coppens E, Willeput M. Gradual withdrawal from benzodiazepines in residents of homes for the elderly: experience and suggestions for future research. Eur J Clin Pharmacol. 1997;51:355–8.

    CAS  PubMed  Google Scholar 

  87. Parr J, Kavanagh D, Young R, McCafferty K. Views of general practitioners and benzodiazepine users on benzodiazepines: a qualitative analysis. Soc Sci Med. 2006;62:1237–49.

    PubMed  Google Scholar 

  88. Dyas J, Apekey T, Tilling M, Ørner R, Middleton H, Siriwardena N. Patients’ and clinicians’ experiences of consultations in primary care for sleep problems and insomnia: a focus group study. Br J Gen Pract. 2010;60:e180–200.

    PubMed  PubMed Central  Google Scholar 

  89. Walsh J, Erman M, Erwin C, Jamieson A, Mahowald M, Regestein Q, Scharf M, Tigel P, Vogel G, Ware C. Subjective hypnotic efficacy of trazodone and zolpidem in DSMIII-R primary insomnia. Hum Psychopharmacol. 1998;13:191–8.

    CAS  Google Scholar 

  90. Mendelson W. A review of the evidence for the efficacy and safety of trazodone in insomnia. J Clin Psychiatry. 2005;66:469–76.

    CAS  PubMed  Google Scholar 

  91. McCleery J, Sharpley A. Pharmacotherapies for sleep disturbances in dementia. Cochrane Database Syst Rev. 2020;11:CD009178.

    PubMed  Google Scholar 

  92. Krystal A, Durrence H, Scharf M, Jochelson P, Rogowski R, Ludington E, Roth T. Efficacy and safety of doxepin 1 mg and 3 mg in a 12-week sleep laboratory and outpatient trial of elderly subjects with chronic primary insomnia. Sleep. 2010;33:1553–61.

    PubMed  PubMed Central  Google Scholar 

  93. Winokur A, DeMartinis N, McNally D, Zary E, Cormier J, Gary K. Comparative effects of mirtazapine and fluoxetine on sleep physiology measures in patients with major depression and insomnia. J Clin Psychiatry. 2003;64:1224–9.

    CAS  PubMed  Google Scholar 

  94. Zammit G, Wang-Weigand S, Rosenthal M, Peng X. Effect of ramelteon on middle of the night balance in older adults with chronic insomnia. J Clin Sleep Med. 2009;5:34–40.

    PubMed  PubMed Central  Google Scholar 

  95. Mets M, de Vries J, de Senerpont DL, Volkerts E, Olivier B, Verster J. Next-day effects of ramelteon (8 mg), zopiclone (7.5 mg), and placebo on highway driving performance, memory functioning, psychomotor performance, and mood in healthy adult subjects. Sleep. 2011;34:1327–34.

    PubMed  PubMed Central  Google Scholar 

  96. Wade A, Crawford G, Ford I, McConnachie A, Nir T, Laudon M, Zisapel N. Prolonged release melatonin in the treatment of primary insomnia: evaluation of the age cut-off for short- and long-term response. Curr Med Res Opin. 2011;7:87–98.

    Google Scholar 

  97. Riemersma-van der Lek R, Swaab D, Twisk J, Hol E, Hoogendijk W, Van Someren E. Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: a randomized controlled trial. JAMA. 2008;299:2642–55.

    CAS  PubMed  Google Scholar 

  98. Rhyne D, Anderson S. Suvorexant in insomnia: efficacy, safety and place in therapy. Ther Adv Drug Saf. 2015;6:189–95.

    CAS  PubMed  PubMed Central  Google Scholar 

  99. Owen R. Suvorexant: efficacy and safety profile of a dual orexin receptor antagonist in treating insomnia. Drugs Today. 2016;52:29–40.

    CAS  Google Scholar 

  100. Norman JL, Anderson SL. Novel class of medications, orexin receptor antagonists, in the treatment of insomnia—critical appraisal of suvorexant. Nat Sci Sleep. 2016;8:239–47.

    PubMed  PubMed Central  Google Scholar 

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Petrovic, M. (2023). Pharmacotherapy of Insomnia in Older Adults. In: Cherubini, A., Mangoni, A.A., O’Mahony, D., Petrovic, M. (eds) Optimizing Pharmacotherapy in Older Patients. Practical Issues in Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-031-28061-0_27

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