TITLE:
Treating Insomnia in Older Adult Patients: Limiting Benzodiazepine Use
AUTHORS:
Joseph V. Pergolizzi Jr., Robert Taylor Jr., Jo Ann LeQuang, Errol Gould, Robert B. Raffa
KEYWORDS:
Pain, Insomnia, Older Adults, Benzodiazepines, “Z”-Drugs, GABAA Receptor
JOURNAL NAME:
Pharmacology & Pharmacy,
Vol.10 No.3,
March
21,
2019
ABSTRACT: As aging comes, an increased prevalence of medical maladies and chronic pain
independently or interactively disrupt sleep, which in turn can exacerbate
either one. Furthermore, anxiety about pain can further negatively impact
sleep. Fortunately, good quality sleep can improve pain management. Because
benzodiazepine receptor agonists (including the “Z” drugs) can reduce anxiety
and improve sleep, they seem a convenient choice. However, their use in this
population, particularly for more than short-term (guidelines range from 2 to 6 weeks max), is not recommended because of increased likelihood of
falls, further disruption of sleep, dependence, and problems with
discontinuation (withdrawal). Besides, this population is often likely to take concomitant medication for pain or other central nervous system
depressants leading to potentially serious and even life-threatening interactions involving synergistic amplification of respiratory
depression (opioids being a particularly dangerous interaction). Therefore,
insomnia in older adults should ideally be treated with a non-benzodiazepine receptor agonist; if indicated, they may be
used, but should be closely monitored and tapered to avoid long-term adverse
problems (direct or from withdrawal). Older adult patients with insomnia may be
more optimally treated with sleep aids that do not interact with the GABAA receptor.