Sleep disorders are a significant issue in the nursing home population, with prevalence rates from 6 to 65. They can lead to several deleterious effects, such as increasing malaise, falls, and cognitive decline. There are a variety of treatment options, with nonpharmacologic interventions being first line. If nonpharmacologic measures fail, pharmacotherapy can be considered. Melatonin agonists, select antidepressants, suvorexant, and magnesium supplements have data to support their use in the elderly patient with minimal side effects. Medications with safety profiles that indicate the risks may outweigh the benefits should be avoided. These include benzodiazepines, nonbenzodiazepine hypnotics, antihistamines, antipsychotics, and most tricyclic antidepressants. Additionally, the lowest effective dose of any medication is recommended to minimize adverse effects.
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