Marked reductions in the amount of stage 3 and 4 sleep along with increases in the number and duration of awakenings at night have been documented polysomnographically. It has been proposed that the earlier rise in body temperature accompanying the phase advances in the elderly contributes to the fragmentation of sleep episodes. It is this fragmentation that contributes to an impairment of alertness and increased daytime sleep propensity . As we age, our circadian clock advances, causing advanced sleep phase syndrome. Pharmacotherapy is the most common method for treating insomnia.
Bezodiazepine hypnotics are the most commonly prescribed hypnotics.
Furthermore, the development of tolerance and dependence under long-term administration, as well as the occurrence of rebound insomnia upon discontinuation of benzodiazepine hypnotics, have restricted their use in treatment of chronic insomnia. Alternative treatment such as sedating antidepressants may be restricted to the treatment of chronic insomnia patients with drug alcohol dependence in their clinical history. Recently, much has been written about the role of Melatonin in assisting sleep especially related to jet lag sleep difficulties. Melatonin is secreted by the pineal gland at night and is associated with sleep disorders in old age due to decrease in humoral production in the pineal gland as we age. Thus melatonin may play an indirect role in the regulation of nocturnal prolactin secretion.