Management of insomnia and long-term use of sedative-hypnotic drugs in older patients.

hypnotic drugs are prescribed to many older adults despite the nearly 5-fold increased risk of adverse cognitive events associated with their use (95% confidence interval [CI] 1.47 to 15.47), the 2.6-fold increased risk of adverse psychomotor events (95% CI 1.12 to 6.09), the association with falls and hip fractures and the 5-fold increased risk of hospital admission after a motor vehicle collision. The number needed to treat with a sedative-hypnotic drug for improved quality of sleep is 13, whereas the number needed to harm is 6. Harm can include drowsiness, fatigue, headache, nightmares and gastrointestinal disturbances. In the 2012 updated Beers criteria for potentially inappropriate medication use in older adults, a strong recommendation based on highquality evidence has been made to avoid all benzodiazepines in older adults. Yet, 16%–33% of older people living in the community use benzodiazepines, and 54% use them daily. The most widely reported indication is insomnia (64%). People who take benzodiazepines tend to be older women, to have lower education levels, to consume less alcohol but more tobacco, to have higher depression and anxiety scores and to use other psychotropic drugs. The appropriate assessment and management of chronic insomnia is crucial. Insomnia affects quality of life and has been shown to be an independent risk factor for falls (adjusted odds ratio [OR] 1.52, 95% CI 1.38 to 1.66). A current evidence-based consensus guideline can assist clinicians in managing chronic insomnia. In this review, we address questions regarding sedative-hypnotic drugs, their discontinuation and effective alternative options among older adults. This review is based on a systematic literature search (Box 1). Most of the relevant evidence identified consisted of small, short-term, randomized trials. How can long-term use of sedativehypnotic drugs be prevented?