Insomnia

Insomnia is clinically defined as a disturbance to sleep onset, sleep maintenance, or difficulty falling asleep after an awakening. Normal aging in older adults is associated with changes to sleep structure, specifically increased stage N1 sleep, decreased slow-wave sleep, and more fragmented sleep, to name a few. Older adults can also experience a phase advance of their natural sleep pattern. Many factors can affect sleep, and it is important to complete a thorough assessment. This will include a medical and psychiatric history along with medication reconciliation and assessing for potential substance use. A sleep diary can help capture sleeping patterns. Scales such as the Insomnia Severity Index and the Pittsburgh Sleep Quality Index can diagnose and aid in monitoring for response to interventions. In this chapter, we review the evidence for the use of both non-pharmacological and pharmacological interventions in the management of insomnia among older adults.