Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine
by Ron Sterling, M.D. -- July 2005
Thank you for writing! In this column, I have written once about sleeplessness and once about the use of melatonin as a sleep aid. However, I have not written about the various medications that are available to deal with sleep-onset insomnia or sleep fragmentation. Historically, prescribing medications for older adults who experience sleep disorders has been much more complicated than treating younger adults. Many physicians are hoping that Lunesta® will be a much-needed solution.
There are many causes of sleep disorders. About 40% are associated with a primary psychiatric disorder. If a doctor was allowed to ask only one question about sleeplessness, that question should be to determine if there is any depression. If depression is associated with sleep complaints, further investigation should occur. Clinical depression is very treatable. The sleep problems associated with moderate to severe depression usually won't go away without treating the depression.
Here are a few non-medication things to keep in mind: (1) avoid naps as much as possible; (2) avoid alcohol and tobacco in the evening; (3) avoid caffeine after noon (that's right, noon); (4) exercise; (5) wind down -- develop a relaxing routine such as reading in a chair, not in bed, before getting into bed; and, (6) learn a relaxation technique, such as the exercise called "Your Place of Relaxation." (Click here to view the Mind Matters column of December 2002).
The most important behavioral technique for chronic sleep-onset insomnia is to require a consistent waking and arising time. The arising time is what sets our sleep clock. Getting up at the exact same time every day is very important. If behavioral routines do not change sleeplessness and the sleep problem is negatively affecting daytime functioning, it is time to consider prescription medication. I don't recommend over-the-counter (OTC) sleep medications for older adults who have chronic sleeplessness. Older adults are particularly vulnerable to the adverse effects of many of the OTC medications that contain diphenhydramine (Benadryl®) which can negatively impact thinking abilities.
The major older prescription medications that are used for sleep-onset insomnia and fragmented sleep are zolpidem (Ambien®), zaleplon (Sonata®), short-acting benzodiazepines, such as lorazepam (Ativan®) and temazepam (Restoril®), and the antidepressant, trazodone (Desyrel®). These all induce drowsiness.
Unlike the benzodiazepines, Ambien® and Sonata® have the advantage of generally not causing any rebound insomnia or discontinuation symptoms. None of these medications, except Desyrel®, are recommended for long-term use. In addition, the use of Desyrel® for sleep disorders, although quite common, is not approved by the Federal Drug Administration (FDA). The main drawback to all these medications for older adults is that each one of them can cause low blood pressure or interfere with coordination and performance which can lead to falls.
It appears that Lunesta®, the medication that you have asked about, is free of many, if not all of the troublesome side effects of all of the older sedative-hypnotic medications and it is the only sedative that has been approved for long-term use by the FDA. Lunesta® became available on April 1, 2005. Even though it has been thoroughly clinically tested, including for the purposes of long-term use up to 12 months, it will still be some time before we understand the true effectiveness of Lunesta®. There is a learning curve for all newly-released medications.
If there are no contraindications to your father utilizing Lunesta® and your father is not experiencing clinical depression, restless legs syndrome or sleep apnea, Lunesta® may be helpful. -- Best wishes, Dr. Ron.
Ron Sterling, M.D. is a 64 year-old General and Geriatric Psychiatrist with a private practice in Seattle. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to Dr. Ron. Please be assured that your questions and identities are completely confidential and protected. For more information about Dr. Ron and for resources related to senior mental health, please go to SeniorMentalHealth.org. The content offered through Mind Matters is for information only and is not intended for medical, psychiatric, or psychological diagnosis or treatment. Never disregard professional advice or delay seeking it because of something you have read in this column. Read our Disclaimer. If you wish to understand more about Dr. Sterling's potential biases in health care advocacy, please check his Conflicts of Interest Disclosure Statement
Have a great day!
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RON STERLING, M.D.
General Psychiatry with Specialization in Adult Attention Deficit Disorder
Updated October 7, 2007
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