Treating Insomnia in Older Adult Patients: Limiting Benzodiazepine Use
Treating Insomnia in Older Adult Patients: Limiting Benzodiazepine Use作者机构：NEMA Research Inc. Naples FL USA Neumentum Palo Alto CA USA LeQ Medical Angleton TX USA Pernix Therapeutics Morristown NJ USA University of Arizona College of Pharmacy Tucson AZ USA Temple University School of Pharmacy Philadelphia PA USA
出 版 物：《Pharmacology & Pharmacy》 (药理与制药（英文）)
年 卷 期：2019年第10卷第3期
页 面：116-129页
学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学]
主 题：Pain Insomnia Older Adults Benzodiazepines “Z”-Drugs GABAA Receptor
摘 要：As aging comes, an increased prevalence of medical maladies and chronic pain independently or interactively disrupt sleep, which in turn can exacerbate either one. Furthermore, anxiety about pain can further negatively impact sleep. Fortunately, good quality sleep can improve pain management. Because benzodiazepine receptor agonists (including the “Z drugs) can reduce anxiety and improve sleep, they seem a convenient choice. However, their use in this population, particularly for more than short-term (guidelines range from 2 to 6 weeks max), is not recommended because of increased likelihood of falls, further disruption of sleep, dependence, and problems with discontinuation (withdrawal). Besides, this population is often likely to take concomitant medication for pain or other central nervous system depressants leading to potentially serious and even life-threatening interactions involving synergistic amplification of respiratory depression (opioids being a particularly dangerous interaction). Therefore, insomnia in older adults should ideally be treated with a non-benzodiazepine receptor agonist;if indicated, they may be used, but should be closely monitored and tapered to avoid long-term adverse problems (direct or from withdrawal). Older adult patients with insomnia may be more optimally treated with sleep aids that do not interact with the GABAA receptor.
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