SAFE SLEEP: A MODERN LOOK AT INSOMNIA MEDICATIONS FOR SENIORS

Katarzyna Krupa; Katarzyna Kozon; Małgorzata Krzyżanowska; Patrycja Fiertek; Hanna Krupa; Weronika Głowacz; Zuzanna Mioduchowska; Anna Pietrzak; Zofia Szypuła; Zuzanna Burkacka

doi:10.31435/ijitss.3(47).2025.3474

Katarzyna Krupa Wolski Hospital in Warsaw, 01-211 Warsaw, Poland https://orcid.org/0009-0006-3120-8631
Katarzyna Kozon Masovian Brodnowski Hospital, 03-242 Warsaw, Poland https://orcid.org/0009-0009-6536-946X
Małgorzata Krzyżanowska Międzyleski Specialised Hospital in Warsaw, 04-749 Warsaw, Poland https://orcid.org/0009-0003-6287-5777
Patrycja Fiertek Railway Hospital in Pruszków, 05-800 Pruszków, Poland https://orcid.org/0009-0002-8959-2235
Hanna Krupa The Faculty of Medicine and Dentistry, Medical University of Warsaw, 02-091 Warsaw, Poland https://orcid.org/0009-0004-4366-8999
Weronika Głowacz Czerniakowski Hospital in Warsaw, 00-739 Warsaw, Poland https://orcid.org/0009-0009-5481-9509
Zuzanna Mioduchowska Faculty of Medical Dentistry, Medical University of Lublin, 20-059 Lublin, Poland https://orcid.org/0009-0007-8527-4981
Anna Pietrzak Bielanski Hospital, 01-809 Warsaw, Poland https://orcid.org/0009-0007-0950-2233
Zofia Szypuła Międzyleski Specialised Hospital in Warsaw, 04-749 Warsaw, Poland https://orcid.org/0009-0007-1671-5587
Zuzanna Burkacka Bielanski Hospital, 01-809 Warsaw, Poland https://orcid.org/0009-0005-5740-4422

DOI: https://doi.org/10.31435/ijitss.3(47).2025.3474

Keywords: Insomnia, Geriatric Population, Pharmacological Treatment, Hypnotics, Drug Safety, Sleep Quality

Abstract

Background. Insomnia is a common and burdensome condition in older adults, marked by difficulty falling or staying asleep, early awakenings, and non-restorative sleep. Its prevalence increases with age and is linked to cognitive decline, depression, falls, and reduced quality of life. Physiological aging and polypharmacy complicate treatment in this group.

Aim. This paper reviews current pharmacological options for managing insomnia in the geriatric population, focusing on efficacy, safety, and adherence to clinical guidelines.

Materials and Methods. A literature review was conducted using PubMed, Scopus, and Google Scholar. Sources included randomized controlled trials, systematic reviews, meta-analyses, observational studies, and guidelines published up to 2024. Keywords included “insomnia,” “elderly,” “pharmacological treatment,” “hypnotics,” and related terms. Only studies involving patients aged 65+ were analyzed. Data on efficacy, safety, dosing, duration, and guideline recommendations were extracted.

Analysis of Literature. Current guidelines prioritize non-pharmacological treatments. Pharmacotherapy may be considered when behavioral methods are ineffective or unavailable. Prolonged-release melatonin and low-dose doxepin offer the best safety-efficacy balance. Orexin receptor antagonists show promise but are not yet available in Poland. Sedating antidepressants like trazodone, mirtazapine, and mianserin may be cautiously used in patients with comorbid depression or anxiety. Z-drugs and benzodiazepines, despite their efficacy, pose significant risks such as falls, dependence, and cognitive decline. Antihistamines and antipsychotics are generally not recommended due to unfavorable safety profiles.

Conclusion. Pharmacological treatment of insomnia in older adults should be cautious and individualized. Non-drug therapies remain the first-line option. When medications are necessary, the safest agents should be used at the lowest effective doses for the shortest duration. Ongoing research is essential to expand safe therapeutic options.

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SAFE SLEEP: A MODERN LOOK AT INSOMNIA MEDICATIONS FOR SENIORS

Abstract

References

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