What are alternative treatments to melatonin for insomnia in the elderly?

From the Guidelines

Elderly individuals seeking alternatives to melatonin should consider eszopiclone, as it has been shown to improve sleep outcomes in older adults, including reduced sleep onset latency and improved sleep efficiency, according to a 2016 study published in the Annals of Internal Medicine 1.

Alternatives to Melatonin

When considering alternatives to melatonin for elderly individuals, it's essential to prioritize options that have been proven to be effective and safe in this population.

• Eszopiclone, a non-benzodiazepine receptor agonist, has been shown to be effective in improving sleep outcomes in older adults, with a recommended dosage of 1 mg hs in elderly or debilitated patients, as stated in a 2008 study published in the Journal of Clinical Sleep Medicine 1.
• Other alternatives, such as valerian root supplements, magnesium glycinate, L-theanine, chamomile tea, and lavender essential oil, may also be considered, but their effectiveness and safety in elderly individuals may vary.

Important Considerations

When prescribing any sleep medication to elderly individuals, it's crucial to consider the potential risks and benefits, including the risk of falls, cognitive impairment, and interactions with other medications.

• A shared decision-making approach, including a discussion of the benefits, harms, and costs of short-term use of medications, is recommended, as stated in the 2016 study published in the Annals of Internal Medicine 1.
• Additionally, practicing good sleep hygiene, such as maintaining consistent sleep-wake times, avoiding screens before bed, and keeping the bedroom cool and dark, is essential for improving sleep quality in elderly individuals.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Melatonin Alternatives for Elderly

• There are several alternatives to melatonin for treating sleep disorders in the elderly, including:
  • Cognitive Behavioral Therapy for Insomnia (CBT-i) 2
  • Trazodone, a sedating antidepressant 3
  • Light therapy for circadian rhythm disorders 4
  • Dopamine agonists for restless legs syndrome 4, 5
• CBT-i has been shown to be an effective treatment for chronic insomnia in adults, with clinically meaningful effect sizes 2
• Trazodone has been found to improve the results of CBT for primary insomnia in non-depressed patients, and can be used in combination with CBT for the short-term management of chronic primary insomnia 3
• Light therapy can be used to treat circadian rhythm disorders, and can improve sleep and mood in patients with neurocognitive disorders 4
• Dopamine agonists can be used to treat restless legs syndrome, but may have adverse effects with long-term use 4, 5

Non-Pharmacological Approaches

• Non-pharmacological approaches, such as CBT-i and light therapy, are recommended as first-line treatments for sleep disorders in patients with neurocognitive disorders 4
• These approaches can be effective in improving sleep quality and reducing symptoms of sleep disorders, without the risk of adverse effects associated with pharmacological treatments 4, 2

Pharmacological Treatments

• Pharmacological treatments, such as trazodone and dopamine agonists, can be used to treat sleep disorders in the elderly, but should be used with caution and under the guidance of a healthcare professional 4, 3, 5
• The use of benzodiazepines and other sedating medications should be avoided in the elderly, due to the risk of adverse effects and dependence 5