Few studies have compared behavioral treatments to drug therapy. Yet the amount of improvement seen with behavioral therapy is similar to studies of newer sleep medications, says Irwin.
The new sleep medications like Ambien, Sonata, and Lunesta are acknowledged to be safer and have fewer side effects than older sleeping pills. While most are approved for short-term use, they are increasingly being used long term in people with chronic insomnia.
Irwin says there are many unanswered questions about the safety and usefulness of these medications when used long term. But sleep specialist David Neubauer, MD, says the risk of abuse and addiction with the newer sleeping pills appears small.
Neubauer tells WebMD that just as there are many different causes of insomnia in elderly people, there are many potential approaches to treatment.
"Sleep problems are not an inherent part of the aging process, but they are more common in the elderly," he says. "Older people have a greater risk for depression and chronic medical disorders that can undermine sleep. They are also more likely to be taking medications, which can also interfere with sleep."
Managing chronic pain or other medical conditions may be all that is needed to restore normal sleep, he says.
But like younger people, many elderly people with sleep problems will need long-term treatment, which may involve behavioral therapies or a combination of behavioral treatments and sleeping pills. He adds that undertreatment of insomnia is especially common among the elderly.
"It is important to identify and treat insomnia in the elderly because it is a big quality-of-life issue," he says.