Diagnosis, treatment, and associated outcomes of later-life insomnia: a narrative review

Insomnia is highly prevalent in older adults and is associated with a range of health outcomes. Over the past 10 years, there have been several reviews of the literature concerning insomnia and its outcomes among older individuals; however, there is a need for an updated review examining the emerging themes of research in this space to guide clinical practice and research. Accordingly, in this narrative review, we highlight recent research on insomnia in older adults, documenting the evolution of knowledge regarding insomnia and its consequences as people age. Our review describes trends in the prevalence of insomnia and related symptoms in older adults, as well as potential factors contributing to these trends. We also highlight the growing recognition of insomnia-associated outcomes, specifically focusing on brain and heart health. Given challenges in and barriers to identifying and ultimately treating insomnia, we describe shifts in the ways insomnia is treated with applicability to older adults, including through digital therapeutic modalities that have the potential to increase access to evidence-based behavioral therapies. Our review highlights significant advancements in the understanding of insomnia's role in older adults' health and underscores critical priorities for future research. Statement of Significance Insomnia is highly prevalent in older adults and is associated with a growing scope of adverse health outcomes. While barriers exist to its diagnosis and appropriate treatment in older persons, advancements in the field of sleep medicine, such as expanded pharmacological options and digital therapeutics for behavioral sleep treatments, may help address the unmet need for care. Our narrative review seeks to trace these developments in the hopes of spurring future research to address insomnia in the growing population of older adults.