Pharmacological Treatment of Primary Insomnia in Senior Citizens in Spain

A Comprehensive Analysis

Authors

DOI:

https://doi.org/10.37536/RIECS.2024.9.1.403

Keywords:

Sleep Initiation and Maintenance Disorders, Aged, Drug Therapy, Cognitive Behavioral Therapy, Hypnotics and Sedatives, Z-drugs, Antidepressive Agents, Melatonin, Mindfulness, Pregabalin

Abstract

The article examines the problem of primary insomnia in older adults in Spain, focusing on its prevalence and health consequences. It highlights that, unlike secondary insomnia, primary insomnia has no identifiable cause and may be related to factors such as stress, emotional distress, travel and shift work. Using data from the Spanish National Institute of Statistics, the prevalence of insomnia in older adults is analysed, highlighting a higher incidence in women and the 75+ age group. The importance of addressing this problem is emphasised, as insomnia in older adults is associated with serious consequences such as depressive episodes, increased risk of falls, cognitive impairment and reduced quality of life. The study aims to comprehensively examine the management of primary insomnia in this population, evaluating the efficacy of various pharmacological treatments, such as cognitive behavioural therapy, benzodiazepines, benzodiazepine receptor agonists (Z-drugs), antidepressants, melatonin and other options. The pros and cons of each treatment are discussed, including special considerations for older adults. The article highlights the importance of future research to improve the understanding and management of chronic insomnia, underlining the need for large-scale studies of high methodological quality to establish appropriate pharmacological management.

References

Patel D, Steinberg J, Patel P. Insomnia in the Elderly: A Review. Journal of Clinical Sleep Medicine. 15 de junio de 2018;14(06):1017-24.

INE. (2024). Problemas de sueño en las últimas 4 semanas según sexo y grupo de edad. Población de 16 y más años. Instituto Nacional de Estadística.

Yin J, Gong R, Zhang M, Ding L, Shen T, Cai Y, et al. Associations between sleep disturbance, inflammatory markers and depressive symptoms: Mediation analyses in a large NHANES community sample. Progress in Neuro-Psychopharmacology and Biological Psychiatry. agosto de 2023;126:110786.

Aernout E, Benradia I, Hazo JB, Sy A, Askevis-Leherpeux F, Sebbane D, et al. International study of the prevalence and factors associated with insomnia in the general population. Sleep Medicine. junio de 2021;82:186-92.

Kyle SD, Morgan K, Espie CA. Insomnia and health-related quality of life. Sleep Medicine Reviews. febrero de 2010;14(1):69-82.

Patel AK, Reddy V, Shumway KR, Araujo JF. Physiology, Sleep Stages. En: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [citado 10 de diciembre de 2023]. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK526132/

Schäfer SK, Wirth BE, Staginnus M, Becker N, Michael T, Sopp MR. Sleep’s impact on emotional recognition memory: A meta-analysis of whole-night, nap, and REM sleep effects. Sleep Medicine Reviews. junio de 2020;51:101280.

Colvonen PJ, Straus LD, Acheson D, Gehrman P. A Review of the Relationship Between Emotional Learning and Memory, Sleep, and PTSD. Curr Psychiatry Rep. enero de 2019;21(1):2.

MacDonald KJ, Cote KA. Contributions of post-learning REM and NREM sleep to memory retrieval. Sleep Medicine Reviews. octubre de 2021;59:101453.

Reed DL, Sacco WP. Measuring Sleep Efficiency: What Should the Denominator Be? Journal of Clinical Sleep Medicine. 15 de febrero de 2016;12(02):263-6.

REAL ACADEMIA ESPAÑOLA: Diccionario de la lengua española, 23.a ed., [versión 23.7 en línea].

<https://dle.rae.es>.

Chattu V, Manzar Md, Kumary S, Burman D, Spence D, Pandi-Perumal S. The Global Problem of Insufficient Sleep and Its Serious Public Health Implications. Healthcare. 20 de diciembre de 2018;7(1):1.

Cho SJ, Song TJ, Chu MK. Sleep and Tension-Type Headache. Curr Neurol Neurosci Rep. julio de 2019;19(7):44.

Andrijauskis D, Ciauskaite J, Vaitkus A, Pajediene E. Primary Headaches and Sleep Disturbances: A Cause or a Consequence? J Oral Facial Pain Headache. enero de 2020;34(1):61-6.

Kamyab P, Kouchaki H, Motamed M, Boroujeni ST, Akbari H, Tabrizi R. Sleep disturbance and gastrointestinal cancer risk: a literature review. Journal of Investigative Medicine. marzo de 2023;71(3):163- 72.

Chaput JP, McHill AW, Cox RC, Broussard JL, Dutil C, Da Costa BGG, et al. The role of insufficient sleep and circadian misalignment in obesity. Nat Rev Endocrinol. febrero de 2023;19(2):82-97.

Uchmanowicz I, Markiewicz K, Uchmanowicz B, Ko?tuniuk A, Rosi?czuk J. The relationship between sleep disturbances and quality of life in elderly patients with hypertension. CIA. enero de 2019;Volume 14:155- 65.

Dean YE, Shebl MA, Rouzan SS, Bamousa BAA, Talat NE, Ansari SA, et al. Association between insomnia and the incidence of myocardial infarction: A systematic review and meta-analysis. Clinical Cardiology. abril de 2023;46(4):376-85.

Mayer G, Stenmanns C, Doeppner TR, Hermann DM, Gronewold J. Schlaf und Demenz. Z Gerontol Geriat. noviembre de 2023;56(7):556-60.

Selbæk-Tungevåg S, Selbæk G, Strand BH, Myrstad C, Livingston G, Lydersen S, et al. Insomnia and risk of dementia in a large population-based study with 11-year follow-up: The HUNT study. Journal of Sleep Research. agosto de 2023;32(4):e13820.

Walker J, Muench A, Perlis ML, Vargas I. Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer. Clinical Psychology and Special Education. 2022;11(2):123-37.

Bateson AN. Further potential of the GABA receptor in the treatment of insomnia. Sleep Medicine. agosto de 2006;7:S3-9.

By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J American Geriatrics Society. julio de 2023;71(7):2052-81.

Zopiclona Qualigen 7,5 mg.Ficha Técnica del medicamento. The Spanish Agency of Medicines and Medical Devices (AEMPS).

Zolpidem Cinfa 10 mg. Ficha Técnica del medicamento. The Spanish Agency of Medicines and Medical Devices (AEMPS).

Liu Y, Xu X, Dong M, Jia S, Wei Y. Treatment of insomnia with tricyclic antidepressants: a meta-analysis of polysomnographic randomized controlled trials. Sleep Medicine. junio de 2017;34:126-33.

?????. Antidepressants [Internet]. ????????; 2023 [citado 10 de diciembre de 2023]. Disponible en: https://doi.org/10.11477/mf.1416202381

Auld F, Maschauer EL, Morrison I, Skene DJ, Riha RL. Evidence for the efficacy of melatonin in the treatment of primary adult sleep disorders. Sleep Medicine Reviews. agosto de 2017;34:10-22.

Costello RB, Lentino CV, Boyd CC, O’Connell ML, Crawford CC, Sprengel ML, et al. The effectiveness of melatonin for promoting healthy sleep: a rapid evidence assessment of the literature. Nutr J. diciembre de 2014;13(1):106.

Anghel L, Baroiu L, Popazu C, P?tra? D, Fotea S, Nechifor A, et al. Benefits and adverse events of melatonin use in the elderly (Review). Exp Ther Med. 14 de enero de 2022;23(3):219.

Bliwise DL, King AC, Harris RB, Haskell WL. Prevalence of self-reported poor sleep in a healthy population aged 50–65. Social Science & Medicine. enero de 1992;34(1):49-55.

Takagi S, Sugihara G, Takahashi H, Inoue Y. The optimal dose of Ramelteon for the better treatment adherence of delayed sleep–wake phase disorder: a dropout rate study. Front Neurol. 28 de septiembre de 2023;14:1280131.

Wu X, Xue T, Chen Z, Wang Z, Chen G. Orexin Receptor Antagonists and Insomnia. Curr Psychiatry Rep. octubre de 2022;24(10):509-21.

European Medicines Agency. Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 21-24 February 2022 [media release]. 25 Feb 2022.

Perini F, Wong KF, Lin J, Hassirim Z, Ong JL, Lo J, et al. Mindfulness-based therapy for insomnia for older adults with sleep difficulties: a randomized clinical trial. Psychol Med. febrero de 2023;53(3):1038-48.

Prnjavorac B, Kunic S, Skobic N, Gorana N, Zirojevic D, Vukas S, et al. Pregabalin in the Treatment of Peripheral and Central Chronic Neuropathic Pain. Mater Sociomed. 2023;35(1):42.

Cross AL, Viswanath O, Sherman A l. Pregabalin. En: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [citado 10 de diciembre de 2023]. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK470341/

Verma V, Singh N, Jaggi A. Pregabalin in Neuropathic Pain: Evidences and Possible Mechanisms. CN. 31 de enero de 2014;12(1):44-56.

Published

31-05-2024

Issue

Section

Artículos de Revisión