[Insomnia and increased use of sleep medication among seniors: problems and alternative treatment].

OBJECTIVE To investigate the problem of insomnia and increased used of sleep medication among seniors and to look at an alternative form of treatment (cognitive-behavioural therapy [CBT]) that has been adapted specifically for this population.

QUALITY OF EVIDENCE MEDLINE and PsycINFO were searched from 1990 to 2005 using the key words insomnia, elderly (older adults), hypnotics (sleep medication), and cognitive behavior therapy. When discussing the efficacy of treatment, sources quoted offer level I evidence. Studies on the deleterious effects of hypnotics primarily offer level II evidence, so their findings must be interpreted with caution (some studies present conflicting results).

MAIN MESSAGE Insomnia in elderly people is associated with marked distress or deterioration in social or physical functioning. Hypnotics can be dangerous for elderly people because they raise the risk of adverse effects on cognitive function and the risk of drug-drug interactions. Treatment should be based on CBT alone or on a combination of CBT and appropriate pharmaceutical therapy.

CONCLUSION Cognitive-behavioural therapy adapted specifically to the problem of insomnia in seniors is one of the recommended options. The gains often include a notable decrease in use of sleep medication and in the emotional distress associated with insomnia.