What Are The Most Effective Treatments For Insomnia?

Pharmacotherapy is moderately effective when used short-term in conjunction with healthy sleep habits and cognitive behavioral therapy.

Insomnia is a common and often debilitating disorder that is associated with significant negative consequences for physical health and well-being.

Insomnia disorder is defined in the International Classification of Sleep Disorders as complaints of difficulty falling asleep or staying asleep that are associated with consequences during the day and are not due to environmental conditions or inadequate sleep.1 The disorder is classified as chronic if it lasts for at least Passed for 3 months with a frequency of at least 3 times a week. If the disorder meets the symptom criteria but has lasted less than 3 months, it is known as short-term insomnia. Short-term insomnia affects 30 to 50% of the population. 2

The recommended first-line therapies for insomnia are non-pharmacological, such as cognitive behavioral therapy for insomnia (CBT-I), relaxation training, sleep restriction, or stimulus . Pharmacological therapy is added only when necessary.

Who is at risk?

Insomnia can occur at any age, but is particularly common in older people with symptoms in up to 65% of people aged 65 and over.3 Patients with comorbidities such as chronic pain, heart failure, or neurological or pulmonary diseases are at increased risk.4 An increased prevalence of Insomnia is also linked to psychiatric disorders, including anxiety, bipolar and major depression, post-traumatic stress disorder, and substance abuse.5 Patients with a history of traumatic brain injury have a common history of insomnia

Therapeutic options

Agency approved medications for insomnia are in the making Table 7The selection of an insomnia medication is highly individual and includes an assessment of the predominant sleep problems, such as:

Table. FDA-approved drugs for chronic insomnia7

Clinical implications

Off-label and OTC drugs are also used for insomnia, but are generally not recommended. Trazodone is an antidepressant, and although it has been used extensively to treat insomnia for several decades, it is not recommended.8 Dizziness, dry mouth, nasal congestion, nausea, orthostasis, and syncope are common side effects (AEs) of trazodone. OTC sedating antihistamines, such as diphenhydramine and doxylamine, are short-acting and generally have little evidence of efficacy and potential for anticholinergic AEs. 9

Insomnia pharmacotherapy is moderately effective when used short-term in conjunction with healthy sleep habits and CBT-I. In general, non-benzodiazepine receptor agonists are inexpensive first-line options for healthy younger patients for short-term use. Other options include dual receptor antagonists, which are more expensive, or ramelteon, which has no potential for abuse but is not effective for maintaining sleep. Benzodiazepines are generally avoided to treat insomnia, especially in the elderly and those with substance use disorders. Educate patients with insomnia about avoiding alcohol or other sedatives, the importance of regular check-ups, the potential impairment in their ability to drive, and the risks of drowsiness the next day. Insomnia medication may need to be tapered to avoid rebound insomnia while off-set.

References

1. International Classification of Sleep Disorders, 3rd Edition. American Academy of Sleep Medicine; 2014.

2. Ellis JG, Perlis ML, Neale LF, Espie CA, Bastien CH. The natural history of insomnia: focus on the prevalence and incidence of acute insomnia. J Psychiatrist Res. 2012; 46 (10): 1278-1285. doi: 10.1016 / j.jpsychires.2012.07.00

3. Patel D, Steinberg J, Patel P. Insomnia in the elderly: a review. J Clin Sleep Med. 2018; 14 (6): 1017-1024. doi: 10.5664 / jcsm.7172

4. Bhaskar S, Hemavathy D, Prasad S. Prevalence of chronic insomnia in patients and its correlation with comorbidities. J Fam Med Prim Care. 2016; 5 (4): 780-784. doi: 10.4103 / 2249-4863.201153

5. Spiegelhalder K, Regen W, Nanovska S, Baglioni C, Riemann D. Comorbid sleep disorders in neuropsychiatric disorders in the life cycle. Curr Psychiatry Rep. 2013; 15 (6): 364. doi: 10.1007 / s11920-013-0364-5

6. Wickwire EM, Schnyer DM, Germain A, et al. Sleep, insomnia, and circadian health after mild traumatic brain injury in adults: review and research agenda. J neurotrauma. 2018; 35 (22): 2615-2631. doi: 10.1089 / new.2017.5243

7. Comparing the treatments for insomnia. Letter from the pharmacist. Accessed December 27, 2021. https://pharmacist.therapeuticresearch.com/Content/Segments/PRL/2014/Jul/Comparison-of-Insomnia-Treatments-7197

8. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical Practice Guideline for the Pharmacological Management of Chronic Insomnia in Adults: A guideline for clinical practice from the American Academy of Sleep Medicine. J Clin Sleep Med. 2017; 13 (2): 307-349. doi: 10.5664 / jcsm.6470

9. 2019 Expert Panel to Update the American Geriatric Society’s Beer Criteria. The American Geriatrics Society updated AGS Beers’ criteria for potentially inappropriate use in older adults in 2019. J Am Geriatr Soc. 2019; 67 (4): 674-694. doi: 10.1111 / jgs.1576

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