From the FDA Drug Label
Reported clinical literature and experience with trazodone has not identified differences in responses between elderly and younger patients. However, as experience in the elderly with trazodone hydrochloride is limited, it should be used with caution in geriatric patients Serotonergic antidepressants have been associated with cases of clinically significant hyponatremia in elderly patients, who may be at greater risk for this adverse reaction
The recommended treatment for geriatric insomnia is not explicitly stated in the drug label. However, trazodone can be used with caution in geriatric patients. It is essential to consider the potential risk of hyponatremia in elderly patients when using serotonergic antidepressants like trazodone 1.
From the Research
The most effective treatment for geriatric insomnia is a combination of non-pharmacological and pharmacological approaches, with cognitive behavioral therapy for insomnia (CBT-I) being the first-line treatment, as recommended by the most recent study 2.
Non-Pharmacological Approaches
Non-pharmacological approaches are essential in the treatment of geriatric insomnia. These include:
- Sleep hygiene education, which involves maintaining regular sleep schedules, avoiding caffeine and alcohol before bedtime, limiting daytime napping, and creating a comfortable sleep environment 3
- Cognitive behavioral therapy for insomnia (CBT-I), which has shown significant effectiveness in improving sleep quality and should be considered before medications 2
- Regular exercise, particularly in the morning or early afternoon, can also improve sleep quality by regulating circadian rhythms and reducing anxiety 3
Pharmacological Approaches
When medications are necessary, they should be used at the lowest effective dose for the shortest duration possible. Short-term use of medications like low-dose trazodone (25-50mg), mirtazapine (7.5-15mg), or melatonin (1-2mg) may be appropriate 3.
- Traditional sedative-hypnotics such as benzodiazepines and Z-drugs (zolpidem, eszopiclone) should be used cautiously due to increased risk of falls, cognitive impairment, and dependence in older adults 3, 4
- If prescribed, start with half the adult dose and use intermittently rather than nightly 3
Addressing Underlying Conditions
Addressing underlying conditions like depression, anxiety, pain, or sleep apnea is crucial as these often contribute to insomnia in the elderly 3, 4.
- A comprehensive assessment often reveals reversible factors, and non-pharmacological approaches should be considered first 5
- The choice of a hypnotic agent in the elderly is symptom-based, and medications should be selected based on the specific sleep disturbance (e.g., sleep-onset insomnia, sleep maintenance insomnia) 3