Management of insomnia in the geriatric patient

Insomnia in older individuals is common and often undiagnosed, and can lead to significant patient morbidity. A stepwise, thorough history and physical examination, including interviews with the bed partner and use of a sleep diary, are valuable diagnostic adjuncts. Polysomnography should be reserved for patients whose history suggests specific sleep-related breathing or movement disorders of breathing. Contributing physical or psychiatric conditions require treatment as in other geriatric patients. Improved sleep hygiene will often provide symptom relief in mild to moderate insomnia, whereas a number of non-drug treatments can be tried for more refractory cases. Most prescription and over-the-counter medications carry significant risk of adverse events and drug interactions; others demonstrate an acceptable risk to benefit profile and are preferred in older patients.