[Insomnia in the elderly. An under-diagnosed and over-treated syndrome]

In elderly patients, insomnia is a common symptom. Insomnia exerts immediate negative effects on quality of life, but also shows a strong bidirectional relationship with serious medical problems. The complex etiology of insomnia in elderly persons warrants meticulous diagnostic assessment. In patients with secondary insomnia, therapy of the causative factors is initiated. Non-pharmacological therapies and behavioral advice constitute the mainstay of symptomatic treatment of insomnia. However, in elderly persons, the efficacy of these measures has not been well established. In general, the therapeutic benefit of hypnotic drugs is small. On the other hand, most substances may have considerable negative side effects. For short-term symptomatic treatment of acute insomnia, hypnotic drugs may be employed. For this indication, Benzodiazepine receptor agonists and prolonged-release Melatonin are drugs of first choice. Generally, prolonged treatment of chronic insomnia in elderly patients is not indicated due to the unclear long-term efficacy and negative side effects of the hypnotic drugs currently available.