Insomnia in the elderly: Toward a good night's sleep

Insomnia can result from a wide variety of primary and secondary conditions; an accurate history and physical examination is crucial to determine the source of the disturbance. Sleep requirements remain unchanged in most elderly persons, but sleep is less efficient and time spent in deep sleep progressively declines with age. A sleep log helps you assess the nature of sleep problems, as does a history from a bed partner. If you suspect sleep apnea or a sleep-related movement disorder, a sleep study may be worthwhile. Patient education, the promotion of good sleep habits, and careful follow-up are invaluable. Prescribe sedative-hypnotics judiciously since these agents may exacerbate such problems as sleep apnea and delirium, and can lead to falls and fractures.