Review: Sedative hypnotics increase adverse effects more than they improve sleep quality in older persons with insomnia.

M e t h o d s Data sources: MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, and PsycLIT (1966 to 2003); bibliographies of published reviews; and 3 manufacturers of sedative–hypnotics (unpublished studies). Study selection and assessment: English-language randomized controlled trials (RCTs) that compared treatment with sedative–hypnotics (prescription or over-the-counter drugs) for ≥ 5 consecutive nights with placebo or another active treatment in persons ≥ 60 years of age who met predetermined criteria for insomnia. Studies excluded patients with psychiatric disorders or severe or acute physical illness that could disrupt sleep, ensured that participants were cognitively able to complete the subjective outcome assessment, and included a washout period between drug treatments. Studies of barbiturates or chloral hydrate or derivatives were excluded. 24 RCTs (n = 2417, age range 56 to 98 y) met the selection criteria and had extractable data. Individual study quality was assessed using the Jadad criteria. 15 RCTs had quality scores ≥ 4 out of 6. Outcomes: Perceived change in sleep quality, sleep onset latency, total sleep time, number of night awakenings, and adverse events (cognitive, psychomotor, and morning hangover).