Skip to main content Accessibility help
  • Print publication year: 2009
  • Online publication date: August 2010

30 - Sleep medication and traffic safety in the elderly

from Part 3 - Sleepdisorders in the elderly


This chapter reviews the nocturnal sleep disorders associated with Parkinson's disease (PD). The most common sleep disorders in PD include insomnia, REM sleep behavior disorder (RBD), sleep apnea, restless legs syndrome (RLS), and periodic limb movement disorder (PLMD). The diagnosis of RLS in PD patients may be confounded by akathisia and nocturnal motor symptoms. The presence of diurnal variations of symptoms in RLS, and the feeling of inner restlessness without a sensory component in akathisia, may help to differentiate akathisia from RLS. The primary neurodegenerative process of PD, complex medication regimens, age-related changes in the sleep architecture, and co-existent sleep disturbances play an important role in the development of excessive daytime somnolence (EDS). Several objective and subjective diagnostic tools have been used for the diagnosis of EDS in PD patients. Deep brain stimulation (DBS) has become an important treatment option for PD patients with disabling motor complications and dyskinesias.


1. RetchinSM, AnapolleJ. An overview of the older driver. Clin Geriatr Med 1993;9:279–96.
2. BeauregardLA, BarnardPW, RussoAM, WaxmanHL. Perceived and actual risks of driving in patients with arrhythmia control devices. Arch Intern Med 1995;155(6):609–13.
3. MarottoliRA, Mendes De LeonCF, GlassTA, et al. Driving cessation and increased depressive symptoms: prospective evidence from the New Haven EPESE. J Am Geriatr Soc 1997;45:202–6.
4. McKnightAJ, McNightAS. Multivariate analysis of age-related driver ability and performance deficits. Acc Anal Prevent 1999;31:445–54.
5. OwsleyC, BallK, SloaneME, RoenkerDL, BruniJR. Visual/cognitive correlates of vehicle accidents in older drivers. Psychol Aging 1991;6:403–15.
6. StewartRB, MarksRG, PadgettPD, et al. Benzodiazepine use in an ambulatory elderly population: a 14-year overview. Clin Ther 1994;168:118–24.
7. WalshJK, EngelhardtCL. Trends in the pharmacological treatment of insomnia. J Clin Psychiatry 1992;53:10–8.
8. MellingerGD, BalterMB, UhlenhuthEH. Insomnia and its treatment: prevalence and correlates. Arch Gen Psychiatry 1995;42(3):225–32.
9. MorganK. Hypnotic drugs, psychomotor performance and ageing. J Sleep Res 1994;3:1–15.
10. MorinCM, MimeaultV, GagnéA. Nonpharmacological treatment of late-life insomnia. J Psychosom Res 1999;46(2):103–16.
11. StewartR, BessetA, BebbingtonP, et al. Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16–74 years. Sleep 2006;29(11):1391–7.
12. JacksonSHD. Dose optimalisation: the effect of age. Int Congr Series 2001;1220:259–71.
13. RayWA, GriffithMR. Prescribed medications and the risk of falling. Top Geriatr Rehab 1990;5:12–20.
14. RayWA. Psychotropic drugs and injuries among the elderly: a review. J Clin Psychopharmacol 1992;12:386–96.
15. BarR. Recent changes in driving among older adults. Hum Factors 1991;33:597–600.
16. JankeM. Accidents, mileage, and exaggeration of risk. Accident Anal Prev 1991;23:183–8.
17. VersterJC, VeldhuijzenDS, VolkertsER. Residual effects of sleep medication on driving ability. Sleep Med Rev 2004;8:309–25.
18. LouwerensJW, GloerichABM, De VriesG, BrookhuisKA, O’HanlonJF. The relationship between drivers’ blood alcohol concentration (BAC) and actual driving performance during high speed travel. In NoordzijPC, RoszbachR, eds. Alcohol, Drugs and Traffic Safety. Amsterdam: Excerpta Medica; 1987: pp.183–92.
19. VersterJC, VeldhuijzenDS, PatatA, OlivierB, VolkertsER. Hypnotics and driving safety: meta-analyses of randomized controlled trials applying the on-the-road driving test. Curr Drug Safety 2006;1:63–72.
20. BarboneF, McMahonAD, DaveyPG, et al. Association of road-traffic accidents with benzodiazepine use. The Lancet 1998;352:1331–6.
21. VersterJC, VolkertsER, SchreuderAHCML, et al. Residual effects of middle-of-the-night administration of zaleplon and zolpidem on driving ability, memory functions and psychomotor performance. J Clin Psychopharmacol 2002;22:576–83.
22. VersterJC, VolkertsER, JohnsonW, LiddicoatL. Zoplidem and traffic safety: the importance of treatment compliance. Curr Drug Safety 2007;2:220–6.
23. RayWA, FoughtRL, DeckerMD. Psychoactive drugs and the risk of injurious motor vehicle crashes in elderly drivers. Am J Epidemiol 1992;136:873–83.
24. NeutelCI. Risk of traffic accident injury after a prescription for a benzodiazepine. Ann Epidemiol 1995;5:239–44.
25. HemmelgarnB, SuissaS, HuangA, BoivinJ-F, PinardG. Benzodiazepine use and the risk of motor vehicle crash in the elderly. JAMA 1997;278:27–31.
26. LeveilleSG, BuchnerDM, KoepsellTD, et al. Psychoactive medications and injurious motor vehicle collisions involving older drivers. Epidemiology 1994;5:591–8.
27. McGwinG, SimsRV, PulleyL, RosemanJM. Relationship among chronic medical conditions, medications, and automobile crashes in the elderly: a population-based case control study. Am J Epidemiol 2000;152:424–31.