Psychiatric aspects of late-life insomnia

Epidemiological trends towards a 'graying' population make the issue of insomnia in the elderly an increasingly important research and clinical topic. It is often challenging to determine how much of a psychiatric dimension there is to a clinical condition that is best viewed as both as a symptom and a true psychosomatic entity in its own right. To categorize insomnia as either psychiatric or medically based risks oversimplification of the complexities of steep disruption in the elderly. Normal, senescence-related changes in steep architecture and circadian rhythms must be considered, as well as the frequent medical comorbidities that may affect steep. Psychiatric diagnoses to consider include mood and anxiety disorders, which may be affected equally by physiological and psychological changes implicit in old age. Steep disruption related to dementia is of particular interest to clinicians involved with patients in long-term care facilities. Insomnia may occasionally be iatrogenically induced or exacerbated, and particularly antidepressants must be carefully selected for this reason. Light therapy and behavior therapies are important in multimodal treatment of insomnia, and steep hygiene includes both regular physical and social activities to preserve entrainment of circadian rhythms affecting steep. (C) 2003 Elsevier Ltd. All rights reserved.