Comorbidities: Psychiatric, Medical, Medications, and Substances

As the field of medicine continues to advance, people are living longer with more comorbid medical and psychiatric conditions. This higher burden of illness and the numbers of medications used to treat these conditions plays an important role in the quality and quantity of sleep in older adults. In approaching sleep complaints in geriatric patients, it is essential that practitioners recognize the multidimensional mechanisms by which illness impacts sleep. Equally important, a balanced management approach that includes optimizing the underlying illness, adjusting medications, using cognitive-behavioral approaches, and using judicious hypnotic therapy seems justified based on the current evidence. © 2006 Elsevier Inc. All rights reserved.