Skip to main content
SpringerLink
Log in

The Treatment of Sleep Disorders

  • Chapter
Aging and Drug Therapy

Part of the book series: Ettore Majorana International Science Series ((PSLI))

Abstract

Insomnia or sleep difficulty is primarily a symptom rather than an illness. The prevelance of the symptom rises with age so that about 30 per cent of people over the age of 65 feel they are sleeping poorly with a higher incidence in females (for a review, see Mendelson, 1980)1.Surprisingly, many people who complain of insomnia, perhaps the majority, do not get substantially less sleep than those who feel their sleep is adequate. 2 The complaint is often associated with other conditions of which both the subject and the physician may be unaware (Table 1). These include primary psychiatric disorders, such as depression and schizophrenia, sleep induced ventilatory impairment (the sleep apnoea syndromes), nocturnal myoclonus and the restless legs syndrome. Drug induced mental excitement due to concurrent use of CNS stimulants, such as sympathomimetic drugs or caffeine, and rebound hyperexcitability following withdrawal of regular sedation, including alcohol, may also be missed. Hypnotic treatment for some of these disorders can be inappropriate and, in the case of the sleep apnoea syndrome, actually harmful. This brief review will assume that insomnia due to preexisting medical conditions or CNS stimulation has been excluded. The aim of therapy for the remaining patients is an improvement in the subjective quality of sleep since most subjects have sleep latency and sleep times that are within normal limits.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. W. B. Mendelson, “The Use and Misuse of Sleeping Pills” P lenum, New York (1980)

    Book  Google Scholar 

  2. M. A. Carskadon, W. C. Dement, M. M. Mitler, C. Guilleminault, V. P. Zarcone, and R. Spiegel, Self-reports versus sleep laboratory findings in 122 drug-free subjects with complaints of chronic insomnia,Am.J:Psychiat.133: 1382 (1976)

    Google Scholar 

  3. B. L. Frankel, R. D. Coursey, R. Buchbinder, and R. Snyder, Recorded and reported sleep in chronic primary insomnia,Arch.Ger.Psychiat.33: 615 (1976)

    Article  Google Scholar 

  4. D. D. Breimer, and J. M. Van Rossum, Pharmacokinetics of (+) and (-) and - hexobarbitone in man after oral administration,J.Pharm.Pharmacol.25: 762 (1973)

    Article  Google Scholar 

  5. D. D. Breimer, and A. G. De Boer, Pharmacokinetics and relative bioavailability of hepatabarbital and heptobarbital sodium in man after oral administration.,Eur.J.Clin.Pharmacol.9: 169 (1975)

    Article  Google Scholar 

  6. D. D. Breimer, and M. A. C. M. Winten, Pharmacokinetics and relative bioavailability of cyclobarbital calcium in man after oral administration,Eur.J.Clin.Pharmacol.. 9: 443 (1976)

    Article  Google Scholar 

  7. T. Inaba, B. K. Tang, L. Endrenyl, and W. Kalow, Amobarbital - a probe of hepatic drug oxidation in man,Clin.Pharmacol. Ther.20: 439 (1976)

    Google Scholar 

  8. D. D. Breimer, Pharmacokinetics and biopharmaceutical aspects of hypnotic drug therapy.in“Clinical Pharmacy and Clinical Pharmacology” W. A. Go veia, G. Tognoni, and E. Van der Kleijn, eds., New York: North Holland (1976)

    Google Scholar 

  9. M. M. Reidenberg, D. T. Lowenthal, W. Briggs, and M. Gasparo, Pentobarbital elimination in patients with poor renal function,Clin.Pharmacol.Ther.20: 67 (1976)

    Google Scholar 

  10. R. L. Nation, J. Vine, E. J. Triggs, and B. Learoyd, Plasma levels of chlorme thiazole and two metabolites after oral administration to young and aged human subjects,Eur.J.Clin. Pharmacol12: 137 (1977)

    Article  Google Scholar 

  11. EM. Sellers, M. Lang-Sellers, and J. Koch-Weser, Comparative metabolism of chloral hydrate and triclof os,J. Clin. Pharm18: 457 (1978)

    Google Scholar 

  12. H. Curry, D. Riddall, J. G. Gordon, P. Simpson, T. B. Binns, R. K. Rondel, and C. McMartin, Disposition of glutethimide in man,Clin. Phatm. acol. Ther.12 : 849 (19711)

    Google Scholar 

  13. R. E. Irvine, J. Grove, P. A. Toseland, and J. R. Trounce, The effect of age on the hydroxylation of amylobarbitone sodium in man,Br.J.Clin.Pharmacol.1: 41 (1974)

    Google Scholar 

  14. R. E. Vestel, E. A. McGuire, J. D. Tob,in, R. Andreas, M. S. Norris, E. Mezey, Ageing and ethanol metabolism,C1in.Pharmacol.Ther.21: 343 (1977)

    Google Scholar 

  15. D. J. Greenblatt, M. Divoll, J. S. Harmatz, D. S. MacLaughlin, R. I. Shader, Kinetics and clinical effects of flurazepam in young and elderly non-in8omniacs,Clin. Pharmacol. Ther30: 475 (1981)

    Article  Google Scholar 

  16. C. M. Castleden, C. F. George, D. Marcer, and C. Hallett, Increased sensitivity to n trazep am in old age,Brit. med. J1: 10 (1977)

    Article  Google Scholar 

  17. L. Kangas, E. Iisalo, J. Kanto, V. Lehtinen, S. Pynnonen, I. Ruikka, J. Salminen, M. Sillanpaa, and E. Syvalahti, Human pharmacokinetics of nitrazepam: effect of age and diseases,Europ. J. Clin. Pharmacol15: 163 (1979)

    Article  Google Scholar 

  18. J. Kanto, L. Kangas, L. Aaltonen, and H. Hikle, Effect of age on the pharmacokinetics and sedative effect of flunitrazepam,Int. J. Clin. Pharmacol. Ther. Toxicol19: 400 (1981).

    Google Scholar 

  19. M. Humpel, B. Neiuweboer, W. Milius, H. Hanke, H. Wendt, Kinetics and biotransf ormations of lormetazepam. II. Radioimmunologic determinations in plasma and urine of young and elderly subjects: first pass effect.C1in. Pharmacol. Ther28: 673 (1980)

    Article  Google Scholar 

  20. A. Huggett, R. J. Flanagan, P. Cook, P. Crome, D. Corless, Chlormethiazole and temazepam,Brit. med. J281: 475 (1981)

    Article  Google Scholar 

  21. Upjohn Ltd., Technical Report no. 3129-81-9122-029. Effects of age and sex on the pharmacokinetics of triazolam and temazepam in healthy volunteers,. December (1981)

    Google Scholar 

  22. P. Bittencoutt, A. Richens, P. A. Toseland, J. F. C. Wicks, and A. N. Latham, Pharmacokinetics of the hypnotic benzo¬diazepine, temazepam,Br.J.Clin.Pharmacol.8: 37 (1979).

    Google Scholar 

  23. L. M. Fuccella, Bioavailability of temazep am in soft gelatin capsules,Brit. J. Clin. Pharmacol8: 31 (1979)

    Google Scholar 

  24. M. Divoll, D. J. Greenblatt, J. S. Harmatz, R. I. Shader, Effect of age and gender on disposition of temazepam,J.Pharm.Sci.70: 1104 (1981)

    Article  Google Scholar 

  25. S. Salem, C. Kinney, and D. McDevitt, Pharmacokinetics and psychomotor effects of nitrazepam and temazepam in healthy elderly males and females,Brit. J.Clin. Pharmacol 13: 601 (1982)

    Google Scholar 

  26. A. Kales, E. 0. Bixler, J. D. Kales, and M. b. Scharf, Comparative effectiveness of nine hypnotic drugs: sleep laboratory studies,J.Clin.Pharmacol.17: 207 (1977)

    Article  Google Scholar 

  27. A. Kales, J. D. Kales, E. 0. Bixler, and M. B. Scharf, Effectiveness of hypnotic drugs with prolonged use: flurazepam. and pentobarbitol,Clin.Pharmacol.Ther.18: 356 (1975)

    Google Scholar 

  28. A. Kales, E. 0. Bixler, M. Scharf, and J. D. Kales, Sleep laboratory studies of flurazepam: a model for evaluating hypnotic drugs,Clin:Pharmacol.Ther.19: 576 (1976)

    Google Scholar 

  29. G. W. Vogel, K. Barder, P. Gibbons and A. Thurmond, A comparison of the of tects of f lurazepam 30 mg and triazolam 0.5 mg on the sleep of insomniacs,Psychopharmacology47: 81 (1976)

    Article  Google Scholar 

  30. I. Oswald, K. Adam, S. Burrow, and C. Idzikowski, The effect of two hypnotics on sleep. Subjective findings and skilled performance,Advances in the Biosciences12: 51 (1978)

    Google Scholar 

  31. I. Oswald, C. French, K. Adam, and J. Gilham, Benzodiazepine hypnotics remain effective for 24 weeks,Brit. med. J284: 860 (1982)

    Article  Google Scholar 

  32. K. Adam, L. damson, V. Brezinova, and W. M. Hunter, Nitrazepam: lastingly effective but trouble on withdrawal,Brit. med. J1: 1558 (1976)

    Article  Google Scholar 

  33. A. Kales, M. B. Scharf, and J. D. Kales, Rebound insomnia a new clinical syndrome,Science201: 1039 (1978)

    Article  ADS  Google Scholar 

  34. E. O. Bixler, A. Kales, C. R. Soldatos and J. D. Kales, Flunitrazepam, an investigational hypnotic drug: sleep laboratory evaluations,J. Clin. Pharmacol17: 569 (1977)

    Article  Google Scholar 

  35. E. D. Bixler, A. Kales, C. R. Soldatos, M. B. Scharf, and J. D. Kales, Effectiveness of temazepam with short, intermediate and long term use: sleep laboratory evaluation,J.Clin. Pharmacol110 – 18 (1978)

    Google Scholar 

  36. M. M. Mitler, M. A Carskadon, R. L. Phillips, W. R. Sterling, V. P. Zarcone, R. Spiegel, C. Guilleminault, and W. C. Dement, Hypnotic efficacy of temazepam: a long-term sleep laboratory evaluation,Br:J:Clin.Pharmacol.8: 63 (1978)

    Google Scholar 

  37. G, Vogel, A. Thurmond, P. Gibbons, K. Edward, K. Sloan, and K. Sexton, The effect of triazolam on the sleep of insomniacs,Psychopharmacologia (Berlin)41: 65 (1975)

    Article  Google Scholar 

  38. T. Roth, M. Kramer, and T. Lutz, Intermediate use of triazolam: a sleep laboratory study,J.Int.Med. Res. 4: 59 (1976)

    Google Scholar 

  39. A. Kales, J. D. Kales, E. 0. Bixle-r, M. B. Scharf, and E. Russek, Hypnotic efficacy of triazolam: sleep laboratory evaluation of intermediate term effectiveness,J. Clin. Pharmacol.16: 399 (1976)

    Google Scholar 

  40. F. Solomon, C. White, D. Parron, and W. Mendelson, Sleeping pills, insomnia and medical practice,New Engl.J.Med.300: 803 (1979)

    Article  Google Scholar 

  41. P. Piceione, F. Zorick, T. Lutz, T. Grisson, M. Kramer and T. Roth, The; efficacy of triazolam and chloral hydrate in geriatric insomniacs,J.Int:Med:Res.8: 361 (1980)

    Google Scholar 

  42. L. Goldstein, J: Graedon, D. Willard, F. Goldstein, and R: R. Smith, A comparative study of the effects of methaqualone and glutethimide on sleep in male chronic insomniacs,J.Clin.Pharmacol.110: 258 (1970)

    Google Scholar 

  43. R. S. Briggs, C. M. Castleden, C. A. Kraft, Improved hypnotic treatment using chlormethiaz;ol, and temazepam,Brit. med. J1: 601 (1980)

    Article  Google Scholar 

  44. D. J. Greenblatt, M. D. Allen, R. I. Shader, Toxicity of high dose flurazepam in the elderly,Clin.Pharm.Ther.21: 355 (1977)

    Google Scholar 

  45. P. J. Cook, Diazepam pharmacodynamics and ageing; MD thesis Bristol University,(1982) Submitted to examiners:

    Google Scholar 

  46. J. Marks, “The Benzodiazepines. Use, overuse, misuse, abuse” MTP Press Ltd., England (1978)

    Google Scholar 

  47. L. Johnson, and A. D. Clift, Dependence of hypnotic drugs in general practice,Brit. med. J4: 613 (1968)

    Article  Google Scholar 

  48. A. D. Clift, Sleep disturbance in general practice,in“Sleep disturbance and hypnotic drug dependence”A. D. Clif t, ed., Excerpts. Medica (New York) (1975)

    Google Scholar 

  49. J. H. Jaffe., Drug addiction and drug abuse,in“The Pharmacological basis of Therapeutics” 6th Edition, A. Gilman, and T. S. Goodman, eds., Macmillan, New York (1980)

    Google Scholar 

  50. H. Petursson, M. H. Lader, Withdrawal from long-term benzodiazepine treatment,Brit. med. J283: 643 (1981)

    Article  Google Scholar 

  51. A. Kales, M. B. Scharf, J. D. Kales, R Soldatos, Rebound insomnia. A potential hazard following withdrawal of certain benzodiazepines,J.Amer.Med.Assoc,. 241: 1692 (1979)

    Article  Google Scholar 

  52. S. Allen, and I. Oswald, Anxiety and sleep after fosazepam,Br:J:Clin Pharmac. 3: 165 (1976)

    Google Scholar 

  53. K. Morgan, and I. Oswald, Anxiety caused by a short life hypnotic,Brit. med. J284: 942 (1982)

    Article  Google Scholar 

  54. Boston Collaborative Drug Surveillance Program, Clinical depression of the CNS due, to diazepam and chlordiazepoxi. de in relation to cigarette smoking and age,New Engl. J. Med288: 277 (1973)

    Article  Google Scholar 

  55. D. J. Greenblatt, and M. D: Allen, Toxicity of nitrazepam in the elderly: a report from the Boston Collaborative Drug Surveillance Program,Brit.J:Clin.Pharm

    Google Scholar 

  56. J. K. Martilla, R. J. Hammel, B. Alexander, and R. Zushiak, Potential untoward effects of long term use of flurazepam in geriatric patients,J.Amer.Pharm.Assn.17: 692 (1977)

    Google Scholar 

  57. P. J. Cook, A. Huggett, R. Graham-Pole, I. T. Savage, and I. M. James, Hypnotics accumulation and hangover in elderly in-patients: a controlled double blind study of temazopam and nitrazepam,Brit. med. J286: 100 (1983)

    Article  Google Scholar 

  58. M. M. Reidenberg, M. Levy, H. Warner, C. B. Coutinho, M. A. Schwartz, G. Yu, J. Cheripko, Relationship between diazepam dose, plasma level, age and CNS depression,Clin.Pharmacol. Ther.23: 371 (1978)

    Google Scholar 

  59. H. G. Giles, G; M. M. cLeod, J. R. Wright, E. M. Sellers, Influence of age and previous use on diazepam dosage required for endoscopy,J. Can. Med. Assn, 118: 513 (1978)

    Google Scholar 

  60. C. G. Swift, J. M. Haythorne,. P. Clarke, I. H. Stevenson The effect of ageing on measured responses to single doses of,oral temazepam,Brit.J: Clin.Pharm. 11: 413 (1981)

    Google Scholar 

  61. A. N. Nicholson, Performance studies with diazepam and its hydroxylated metabolites,Br.J.Cl n.Pharm.8: 39 (1979)

    Google Scholar 

  62. T. Roth, P. Piccione, P. Salis, M. Kramer, and M. Kaffeman, Effects of temazepam, flurazepam and quinalbarbitone on sleep: psychomotor and cognitive function,Br.J.Clin.Pharm.8: 47 (1979)

    Google Scholar 

  63. T. Roth, F. Zorick, J. Sicklesteel, and E. Stepanski, Effects of benzodiazepines on sleep and wakefulness,Br.J.Clin. Pharmacol.11: 31 (1981)

    Google Scholar 

  64. I. Hindmarch, Effects of hypnotic and sleep-inducing drugs on objective assessments of human psychomotor performance and subjective appraisals of sleep and early morning behaviour,Br.J.Clin.Pharmacol.8: 43 (1979)

    Google Scholar 

  65. A. Harenko, A comparison between chlormethiazole and nitrazepam as hypnotics in psycho-geriatric in-patients,Curr.Med.Res. Opn.10: 657 (1975)

    Article  Google Scholar 

  66. M. Linnoila and M. Viukari, Efficacy and side effects of nitrazepam and thioridazine as sleeping aids in psychogeriatric in patients,Br.J.Psychiat. 128: 566 (1978)

    Article  Google Scholar 

  67. A. N. Exton-Smith and D. J. Witts, A comparison of chlormethiazole and nitrazep am as hypnotics in elderly subjects, with a note on the pharmacokinetics of chlormethiazole,in“Current Trends in Therapeutics in the Elderly” A. N. Exton-smith, ed., Medical Education Services Ltd. Oxford, (1980)

    Google Scholar 

  68. M. Viukari, M. Linnoila and V. Aalto, Efficacy and side effects of flurazepam, fosazepam and nitrazepam as sleeping aids in psychogeriatric patients,Acta.Pgychiat.Scand.57: 27 (1978)

    Article  Google Scholar 

  69. J. M. Fillingim, Double blind evaluation of temazepam, flurazepam, and placebo in geriatric insomniacs,Clin.Ther.4: 369 (1982)

    Google Scholar 

  70. D. J. Greenblatt, M. Divoll, D. R. Abernethy and R. I. Shader, Benzodiazepine hypnotics: kinetic and therapeutic options,Sleep5: S23 (1982)

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Royal Free Hospital, London, UK

    Peter J. Cook (Honorary Lecturer in Clinical Pharmacology)

Authors
  1. Peter J. Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Institute of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy

    G. Barbagallo-Sangiorgi

  2. School of Medicine, University College London, London, England

    A. N. Exton-Smith

Rights and permissions

Reprints and permissions

Copyright information

© 1984 Plenum Press, New York

About this chapter

Cite this chapter

Cook, P.J. (1984). The Treatment of Sleep Disorders. In: Barbagallo-Sangiorgi, G., Exton-Smith, A.N. (eds) Aging and Drug Therapy. Ettore Majorana International Science Series. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-2791-2_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-4613-2791-2_7

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4612-9721-5

  • Online ISBN: 978-1-4613-2791-2

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation