2014, Number 1
<< Back
Rev Med Inst Mex Seguro Soc 2014; 52 (1)
Clinical practice guideline. Diagnosis and treatment of insomnia in the elderly
Medina-Chávez JH, Fuentes-Alexandro SA, Gil-Palafox IB, Adame-Galván L, Solís-Lam F, Sánchez-Herrera LY, Sánchez-Narváez F
Language: Spanish
References: 37
Page: 108-119
PDF size: 101.86 Kb.
ABSTRACT
Insomnia is the diffi culty to initiate or to maintain sleep. It also has to do
with waking up too early at least for a month. A patient with insomnia has
daytime consequences such as fatigue, sleepiness, changes in mood,
lose of concentration, as well as changes in his social performance and
his family relationships, among others. The relationship between this disorder
and physical and mental health is important due to the impact that
it has on the quality of life and life expectancy of those who suffer from it.
Unfortunately, insomnia usually goes unnoticed or untreated, which contributes
to the onset or worsening of psychiatric and medical conditions.
This exacerbates the problem of insomnia in the elderly people.
In relation to the treatment it is recommended: 1) the search and management
of secondary causes of insomnia, 2) a non-drug therapy that
includes sleep hygiene measures, 3) pharmacotherapy. It is not recommended
to start a treatment with a hypnotic drug without rule out
medications or diseases that cause or exacerbate insomnia. It is not
recommended the use of narcoleptics, melatonin, antihistamines or
long half-life benzodiazepines. The consequences include limitations
on activities of daily living, loss of functionality, impaired quality of life,
increased morbidity and mortality, as well as the worsening of preexisting
chronic conditions.
REFERENCES
Hajak G; SINE Study Group. Study of Insomnia in Europe. Epidemiology of severe insomnia and its consequences in Germany. Eur Arch Psychiatry Clin Neurosci. 2001;251(2),49-56.
Lichstein KL. Secondary insomnia: a myth dismissed. Sleep Med Rev. 2006;10(1):3-5.
Isaia G, Corsinovi L, Santos-Pereira P, Michelis G, Aimonino N, et al. Insomnia among hospitalized elderly patients: prevalence, clinical characteristics and risk factors. Arch Gerontol Geriatr. 2011;52(2), 133-7.
Jaussent I, Dauvilliers Y, Ancelin ML, Dartigues JF, Tavernier B, Touchon J, et al. Insomnia symptoms in older adults: associated factors and gender differences. Am J Geriatr Psychiatry. 2011;19(1),88- 97. Texto libre http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3179987/
Avidan AY. Epidemiology, assessment and treatment of insomia in the elderly patient. Medscape Neurology [Internet] 2005;7(2). Disponible en http:// www.medscape.org/viewarticle/516282
Mahowald MW, Bornemann MA. Sleep complaints in the geriatric patient. Minn Med. 2007;90(10),45-7.
Daley M, Morin CM, LeBlanc M, Gregoire JP, Savard J. The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep. 2009,32(1),55-64. Texto libre http://www.ncbi.nlm. nih.gov/pmc/articles/PMC2625324/
American Academy of Sleep Medicine. The Interna tional Classifi cation of Sleep Disorders Diagnostic Coding Manual. 2 ed. Westchester, Illinois: American Academy Sleep Medicine; 2005.
Kamel NS, Gammack JK. Insomnia in the elderly: cause, approach, and treatment. Am J Med. 2006:119 (6);463-9.
Hilty D, Young JS, Bourgeois JA, Klein S, Hardin KA. Algorithms for the assessment and management of insomnia in primary care. Patient Prefer Adherence. 2009;3:9-20. Texto libre http://www.ncbi. nlm.nih.gov/pmc/articles/PMC2778437/
Zee PC, Reid KJ. Circadian Rhythm Sleep Disorders En: Carney PR, Richard B, Geyer JD. Editores. Clinical Sleep Disorders. Philladelphia: Lippincott Williams & Wilkins; 2005. p. 243-54.
Taylor DJ, Mallory LJ, Lichstein KL, Durrence HH, Riedel BW, Bush AJ. Comorbidity of chronic insomnia with medical problems. Sleep.2007;30(2):213-8.
Yokoyama E, Kaneita Y, Saito Y, Uchiyama M, Matsuzaki Y, Tamaki T, et al. Association between depression and insomnia subtypes: a longitudinal study on the elderly in Japan. Sleep. 2010;33(12), 1693-702. Texto libre http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC2982740/.
Barczi SR. Sleep and Medical Comorbidities. En: Avidan AY, Alessi CA. Editores. Geriatric Sleep Medicine. New York: Informa Healthcare; 2008. p. 19-36.
Kim JM, Stewart R, Kim SW, Yang SJ, Shin IS, Yoon JS. Insomnia, depression, and physical disorders in late life: a 2-year longitudinal community study in Koreans. Sleep. 2009;32(9):1221-8.
Roehrs T, Roth T. The effect of drugs on sleep quality and architecture [Internet]. September 2009. Version 17.3 www.uptodate.com.
Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003; 163(22):2716-24.
Wilson KG, Eriksson MY, D’Eon JL, Mikail SF, Emery PC. Major depression and insomnia in chronic pain. Clin J Pain. 2002;18(2):77-83.
Schweitzer PK. Effects of Drugs on Sleep. En: Barkoukis TJ, Avidan AY, editores. Review of Sleep Medicine. 2nd ed. ed. Philadelphia: Butterworth- Heinemann Elsevier; 2007. p. 169-84.
Ringdahl EN, Pereira SL, Delzell JE Jr. Treatment of primary insomnia. J Am Board Fam Pract. 2004;17 (3):212-9.
Medina-Chávez H. Trastornos del sueño en ancianos. En: Rodríguez R, Lazcano G, Medina H, Hernández MA. Editores. Práctica de la geriatría. 3a ed. México; McGraw-Hill Interamericana; 2011. p. 596-605.
Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487-504.
Harrington JJ, Lee-Chiong T Jr. Sleep and older patients. Clin Chest Med. 2007. 28(4):673-84.
National Institutes of Health. State of the Science Conference Statement on Manifestations and management of Chronic Insomnia in Adults. June 13-15, 2005. Sleep. 2005;28(9):1049-57.
Organización Médica Colegial de España; Ministerios de Sanidad y Consumo. Guía de Buena Práctica Clínica en Patología del Sueño. España: International Marketing & Communication; 2005.
Pallesen S, Nordhus IH, Kvale G. Nonpharmacological interventions for insomnia in older adults: a meta-analysis of treatment effi cacy. Psychotherapy. 1998;35(4):472-82.
McCrae CS. Late-life comorbid insomnia: diagnosis and treatment. Am J Manag Care. 2009;15 (Suppl); S14-S23.
Kamel NS, Gammack JK. Insomnia in the elderly: cause, approach, and treatment. Am J Med. 2006: 119(6);463-9.
Tariq SH, Pulisetty S. Pharmacotherapy for insomnia. Clin Geriatr Med. 2008;24(1):93-105.
Ministry of Health. MOH Clinical Practice Guidelines. Prescribing of Benzodiazepines [Internet]. Singapur: Ministry of Health; 2008. Disponible en http://www. moh.gov.sg/content/dam/moh_web/HPP/Doctors/ cpg_medical/current/2008/CPG_Prescribing%20 of%20Benzodiazepines_Booklet.pdf
Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, et al. The effi cacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCT´s. J Gen Intern Med. 2007;22 (9):1335-50.
Lichstein KL, Wilson NM, Jonhson CT. Psychological treatment of secondary insomnia. Psychol Aging. 2000;15(2):232-40.
Zhdanova IV, Wurtman RJ, Regan MM, Taylor JA, Shi JP, Leclair OU. Melatonin treatment for agerelated insomnia. J Clin Endocrinol Metab. 2001;86 (10):4727-30.
Brzezinski A, Vangel MG, Wurtman RJ, Norrie G, Zhdanova I, Ben-Shushan A, et al. Effects of exogenous melatonin on sleep: a meta-analysis. Sleep Med Rev. 2005;9(1):41-50.
Montgomery P, Lily J. Insomnia in the elderly. Clinical Evidence. 2007;10:2302.
Fernandez-San Martin MI, Masa-Font R, Palacios- Soler L, Sancho-Gómez P, Calbó-Caldentey C, Flores-Mateo G. Effectiveness of Valerian on insomnia: a meta-analysis of randomized placebocontrolled trials. Sleep Med. 2010;11(6):505-11.
Reid KJ, Martinovich Z, Finkel S, Statsinger J, Golden R, Harter K, et al. Sleep: a marker of physical and mental health in the elderly. Am J Geriatr Psychiatry. 2006;14(10):860-6.