A NARRATIVE REVIEW ON THE MANAGEMENT OF INSOMNIA IN OLDER ADULTS: INTEGRATING WESTERN AND TRADITIONAL CHINESE MEDICINE PERSPECTIVES

Abstract

Objective: To review and synthesize the current clinical approaches for treating insomnia in the older adult population, drawing from both Western medicine and Traditional Chinese Medicine (TCM).

Background: The global population is aging rapidly, and with this demographic shift, the prevalence of insomnia among older adults has become a significant public health concern (Chaplin et al., 2025; Tampi, 2024). Insomnia, characterized by difficulty initiating or maintaining sleep, affects up to 50% of the elderly population and is associated with a decline in quality of life, an increased risk of chronic diseases, cognitive impairment, and falls (Abad & Guilleminault, 2018; Hedges & Gotelli, 2019). While numerous treatments exist, they each present a unique set of advantages and challenges.

Summary: This review examines the primary therapeutic modalities for insomnia in the elderly. Western medical treatments are broadly categorized into pharmacological and non-pharmacological interventions. Pharmacological agents, such as benzodiazepine receptor agonists (BZRAs), offer rapid, short-term relief but carry substantial risks for older adults, including dependency, cognitive side effects, and an increased risk of falls (American Geriatrics Society Beers Criteria® Update Expert Panel, 2023; Poelgeest et al., 2021). Non-pharmacological approaches, particularly Cognitive Behavioral Therapy for Insomnia (CBT-I), are recommended as the first-line treatment due to their long-term efficacy and safety (Park et al., 2024; Riemann et al., 2023), though their accessibility can be limited by cost and the availability of trained practitioners (Schotland et al., 2024). Concurrently, Traditional Chinese Medicine offers a variety of therapies, including acupuncture, moxibustion, herbal medicine, and aromatherapy, which are gaining popularity due to their holistic nature and favorable safety profiles (Ye et al., 2024; Zhao et al., 2023). These TCM methods aim to restore the body's natural balance to promote sleep.

Conclusion: The management of insomnia in older adults is complex, requiring a careful balance between efficacy and safety. While Western medicine provides powerful tools, their long-term use is often problematic in this demographic (Ancoli-Israel et al., 2005). TCM offers promising, less invasive alternatives that align well with a holistic approach to geriatric care (Wang et al., 2023). There is a clear clinical need for an integrated approach that leverages the strengths of both systems to provide safe, effective, and accessible solutions for managing insomnia in the aging population.