Insomnia in special populations: effects of aging, menopause, chronic pain, and depression.

Abstract

Chronic insomnia is highly common in adults, and certain population groups are particularly prone to sleep disturbances, including the elderly, women in menopausal transition, persons with chronic pain, and those with depression. Diagnosis and treatment of insomnia in such patients may be problematic because of (1) the presence of one or more comorbid medical illnesses, as in the elderly or patients with a chronic pain syndrome, (2) the presence of depressive symptoms, or (3) the patient's underlying physiologic status (eg, hormone fluctuations due to perimenopause). Effective management of sleep disturbances in these special populations requires an integrative approach to evaluation in the context of the underlying condition and to concurrent treatment of the sleep disturbance and any coexisting medical condition or associated symptom. The contributors to this article discuss insomnia as it is experienced by each of these populations and present representative case examples and proposed treatment plans for each.