Lam Sum, Macina Lucy O
Consult Pharm. 2017 Oct 1;32(10):610-622. doi: 10.4140/TCP.n.2017.610.
To offer an update on insomnia in older adults and treatment options.
A search of PubMed using the terms "insomnia" and "older adults" was performed. Current guidelines, review articles, and drug database and manufacturer package inserts were utilized to provide relevant information.
All English-language articles from 2012 to February 2017 and their bibliographies were reviewed for relevance. Current guidelines from the American College of Physicians, the American Academy of Sleep Medicine, and the American Geriatrics Society's Beers criteria were reviewed.
Insomnia is a frequent complaint in the elderly. Treatment guidelines for this specific population are lacking. Anticholinergics, doxepin > 6 mg, benzodiazepines (BZDs), and non BZD receptor agonists (BzDRAs) are potentially inappropriate drugs for older adults. For adults with chronic insomnia, sleep hygiene practices and cognitive behavioral therapy should be considered as the initial treatments. If drug therapy is required or desired, the guidelines recommend short-term uses of BZDs (triazolam or temazepam), BzDRAs, low-dose doxepin (≤ 6 mg), ramelteon, or suvorexant. Risks and benefits of pharmacotherapy should be discussed with patients and caregivers prior to treatment initiation. Frequent and regular monitoring for adverse events is warranted to prevent detrimental outcomes.
Nonpharmacologic interventions are the first-line therapy for adults with chronic insomnia. Short-term drug therapy may be considered as an alternative or add-on treatment. Hypnotic use is associated with harm and requires close monitoring, especially in older adults.
提供关于老年人失眠及治疗选择的最新信息。
使用“失眠”和“老年人”这两个术语在PubMed上进行检索。利用当前指南、综述文章、药物数据库及药品制造商包装说明书来提供相关信息。
对2012年至2017年2月期间所有英文文章及其参考文献进行相关性审查。审查了美国医师学会、美国睡眠医学会的当前指南以及美国老年医学会的Beers标准。
失眠是老年人常见的主诉。针对这一特定人群缺乏治疗指南。抗胆碱能药物、多塞平剂量>6mg、苯二氮䓬类药物（BZDs）以及非苯二氮䓬受体激动剂（BzDRAs）对老年人来说可能是不合适的药物。对于患有慢性失眠的成年人，睡眠卫生措施和认知行为疗法应被视为初始治疗方法。如果需要或期望进行药物治疗，指南推荐短期使用BZDs（三唑仑或替马西泮）、BzDRAs、低剂量多塞平（≤6mg）、雷美替胺或苏沃雷生。在开始治疗前，应与患者及护理人员讨论药物治疗的风险和益处。有必要对不良事件进行频繁且定期的监测，以预防有害后果。
非药物干预是慢性失眠成年人的一线治疗方法。短期药物治疗可被视为一种替代或辅助治疗。使用催眠药物存在危害，需要密切监测，尤其是在老年人中。
