[Pharmacotherapy of sleep disorders in elderly patients]

Elderly patients often suffer from sleep disturbances. Disorders are mostly caused by medical, neurological or psychiatric diseases and multimorbidity. The treatment of the underlying disease should therefore be prioritised. In the symptomatic treatment of insomnia cognitive-behavioural strategies are established. Drug therapy should be considered only if non-pharmacological treatments fail. Most hypnotics have a poor risk-benefit ratio in older patients. In acute severe sleep disturbances prescription of short-acting benzodiazepines and nonbenzodiazepine hypnotics in low doses over a short period of time is acceptable. In patients suffering from chronic insomnia a treatment with sedative antidepressants can be considered keeping in mind possible adverse effects. Studies analysing the current status of care for elderly insomnia patients in Germany are limited. Analyses of health insurance data suggest that especially nursing home patients often use hypnotics. The treatment of sleep disorders in elderly patients must therefore be optimized in practice.