Tranquilizers and sedative/hypnotics: appropriate use in the elderly.

In treating the elderly patient, it is generally true that the fewer pharmacologic agents needed, the less the potential for drug interactions and puzzling toxic reactions. Nevertheless, sedative/hypnotics and anxiolytic drugs (mostly the benzodiazepines) are safe and effective therapy for the older patient, when the appropriate indications and dosages are observed. On the other hand, the toxic potential of nonbenzodiazepines (eg, barbiturates and pseudobarbiturates) and of even the relatively safe alternatives (eg, chloral hydrate, diphenhydramine, and hydroxyzine) render them less useful for the treatment of sleep disturbances. A final nonpharmacologic note: the physician should bear in mind that a balanced medical and psychological approach to sleep disturbance and anxiety in the elderly often yields success. This includes establishing a bedtime routine and using behavioral techniques, such as relaxation training, biofeedback, and even self-hypnosis. Patients can often be referred to a center where these approaches are employed.