Which medication is considered first choice for insomnia in elderly patients?

Benzodiazepines are considered a first choice for managing insomnia in elderly patients due to their effectiveness in promoting sleep and their relatively rapid onset of action. In the context of insomnia, benzodiazepines help by enhancing the effects of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain, leading to sedation and improved sleep initiation.

While they can have side effects, their use is often warranted in older adults, particularly when non-pharmacological approaches have not been effective. It's important to choose a short-acting benzodiazepine that minimizes daytime sedation and cognitive impairment, which are significant concerns in the elderly population.

Other options, such as barbiturates, may not be considered first-line due to their potential for dependence and overdose risks. Cholinesterase inhibitors are primarily used for cognitive enhancement in conditions like Alzheimer's disease, and beta-blockers, while they can help with performance anxiety and have some sleep effects, are not primarily indicated for treating insomnia. Thus, benzodiazepines represent a more targeted and effective approach for elderly patients experiencing insomnia.