Sleeping pills for the elderly: are they ever justified?

Sleep disturbances in the elderly are common but not trivial. They are almost always multiply determined by age-dependent changes in sleep (amount, composition, and circadian distribution), concurrent medical/neuropsychiatric disorders and their treatments, and psychosocial/environmental changes. Against this complex background, the widespread use of sleeping pills to treat insomnia in the elderly is inadequate and--because of delay in diagnosis, adverse effects on respiration during sleep, and impairment of daytime alertness--potentially dangerous. A more thoughtful, less reflexive, approach to the prescription of sleeping pills in the elderly is suggested.