Review of Insomnia Pharmacotherapy Options for the Elderly: Implications for Managed Care

Abstract The prevalence of insomnia in the elderly is significant. If left untreated or inappropriately treated, insomnia may contribute to increased health care resource use. Therefore, better identification and management of insomnia is required for this patient population. The etiology and magnitude of insomnia due to changes in circadian rhythms, comorbid conditions, and pharmaceutical agents are not well documented, and the utilization of over-the-counter and non-Food and Drug Administration (FDA)-approved agents to induce sleep (including antihistamines and ethyl alcohol) have not been studied in a natural setting. Evaluating the actual type of insomnia remains much more art than science for the majority of patients and providers. Another issue to consider in this population involves the relationship between patient and physician and the traditional passive patient role. Nonpharmacologic approaches (ie, cognitive behavioral therapy) for insomnia management are effective and usually are first-line th...