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Review: sedative hypnotics increase adverse effects more than they improve sleep quality in older persons with insomnia

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 Q In older persons with insomnia, what are the benefits and risks of short term use of sedative hypnotics?

Clinical impact ratings GP/FP/Primary care ★★★★★☆☆ Psychiatry ★★★★★★☆ Geriatrics ★★★★★★☆ Mental health ★★★★★☆☆


Embedded ImageData sources

Medline, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, and PsycLIT (1966–2003); bibliographies of published reviews; and 3 manufacturers of sedative hypnotics (unpublished studies).

Embedded ImageStudy selection and assessment

English language randomised controlled trials (RCTs) that compared treatment with sedative hypnotics (prescription or over the counter drugs) for ⩾5 consecutive nights with placebo or another active treatment in persons ⩾60 years of age who met predetermined criteria for insomnia. Studies excluded patients with psychiatric disorders or severe or acute physical illness that could disrupt sleep, ensured that participants were cognitively able to complete the subjective outcome assessment, and included a washout period between drug treatments. Studies of barbiturates or chloral hydrate or derivatives were excluded. 24 RCTs (n = 2417, …

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  • * Calculated from data in article.

  • For correspondence: Dr U E Busto, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. usoa_busto{at}

  • Source of funding: no external funding.