Insomnia in elderly individuals is a serious concern. Inadequate sleep increases the odds of falling or other accidents which often result in lifetime disability or loss of independence. Furthermore, rates of insomnia are notably higher in the elderly, as opposed to young adults. In one study, more than half of elderly people in primary care report insomnia-like symptoms.
Despite the prevalence of elderly insomnia, there have been few clinical investigations designed to understand the issue or assess the safety of various pharmaceutical approaches to the problem. In the current state of affairs, elderly patients with insomnia may undergo prolonged treatment regimens with any one of a number of medications. The safety of prolonged insomnia medication usage has been called into question, especially among the elderly.
More recently, a study of Sinequan (doxepin), an antidepressant medication, offered hope for elderly people with chronic insomnia. Typically prescribed for depression and anxiety, Sinequan affects the brain in ways that appear to improve both the duration and quality of sleep. This effect is observable even at daily doses as low as 1 mg. A 12-week study conducted at several sleep centers demonstrated that 1- and 3-mg doses of Sinequan administered half an hour before bedtime contributed to better sleep.
Researchers recorded sleep information with an instrument known as a polysomnograph, confirming that sleep quality improved throughout the study. Participants were less likely to wake at night and reported a greater sense of alertness the following day. Most importantly, adverse side effects were actually less common in the drug group than the placebo group. Headache and sleepiness were the most frequently reported side effects, but rarely were these effects powerful enough to cause withdrawal from the study.
Because the study only lasted 12 weeks, researchers could not make conclusions about the long-term safety of Sinequan. However, its safety and tolerability appear very high. Additionally, the low doses used in the study—1 and 3 mg—effectively minimize the risks of adverse effects. For elderly patients suffering from chronic sleeplessness, Sinequan may be a viable solution. The potential ill effects of insomnia are simply too great to be ignored. Future research may investigate the long-term effects of Sinequan in elderly populations.
Krystal, A.D., Durrence, H.H., Scharf, M., Jochelson, P., Rogowski, R., Ludington, E., and Roth, T. (2010). Efficacy and safety of doxepin 1 mg and 3 mg in a 12-week sleep laboratory and outpatient trial of elderly subjects with chronic primary insomnia. Sleep, 33, (11), 1553-1561.
© Copyright 2011 by James Pendleton. All Rights Reserved. Permission to publish granted to GoodTherapy.org.