Common agents used to treat anxiety include benzodiazepines, buspirone (Buspar™) and antidepressants. Sleep disorders can be treated with non-pharmacological measures such as behavioral modification, drinking warm milk before bedtime, avoiding caffeine and stimulants during the afternoon and avoiding a diuretic before nighttime. It is normal for older people to sleep less "deeply" than when they were younger.

AgeWorks: Sleep

If a medication must be prescribed, antihistamines, zolpidem (Ambien™), antidepressants and benzodiazepines may be used.

• Benzodiazepines have antianxiety, hypnotic and anticonvulsive effects. Benzodiazepines can be short-acting, intermediate-acting and long-acting types. Short-acting benzodiazepines have a half-life of approximately 5-15 hours while long-acting benzodiazepines have a half-life of approximately 30-100 hours. The longer the half-life, the longer it takes to be eliminated from the body. Flurazepam (Dalmane™) has one of the longest half-lives. It should be avoided in the older adult due to its propensity to cause excess daytime sedation and confusion. Furthermore, if a patient were to take it for multiple nights, the time it takes to eliminate from the body grows even longer resulting in lethargy and stupor.
  
  Intermediate acting benzodiazepines such as temazepam (Restoril™), lorazepam (Ativan™) and oxazepam (Serax™) are preferred choices for those patients who have trouble staying asleep or falling asleep. The lowest effective dose should always be used first. Triazolam (Halcion™), a very short acting benzodiazepine. While it is a useful agent due to its short half-life, however it is quite potent and causes retrograde amnesia. It should generally be avoided in the elderly. Tolerance eventually builds to benzodiazepine usage and therefore is no longer effective.
  
  Non-benzodiazepine hypnotics such as Zolpidem (Ambien™) are useful for treating insomnia. It is short acting and breaks down to non-active metabolites. It causes less daytime sedation and does not cause rebound insomnia upon discontinuation. It is generally well tolerated by the elderly.
  
  Antihistamines such as diphenhydramine (Benadryl™) are also prescribed for sleep. Diphenhydramine can be obtained over the counter and is beneficial for short- term use. It's side effects include dry mouth, urinary retention, blurred vision, constipation and over sedation in the morning. It should not be used by individuals with benign hyperthrophy.
  
  Barbiturates such as pentobarbital (Nembutal™) are generally not recommended for older adults because they have a long duration of action that may cause excess sedation and respiratory depression. Barbiturates can also cause stimulation in some older patients. Barbiturates have many drug interactions and they have a higher propensity for tolerance and can be habit forming.
  
  Antianxiety agents such as Buspirone (Buspar™) are used for treating anxiety disorders. Buspirone does not cause tolerance or physical and psychological dependence. It is an acceptable choice for elderly patients. It does require a week for the onset of action to occur, so the patient may not feel immediate relief from anxiety. The patient needs to be informed of this delay so that he will does not stop taking the medication.
  
  Antidepressants such as trazodone (Desyrel™) and nefazodone (Serzone™) are commonly used to treat insomnia due to their high sedative effects. The doses are usually much lower than the therapeutic antidepressant dosages and are generally well tolerated.