Pharmacologic Management of Insomnia

Pharmacotherapy is indicated for many types of insomnia, most notably transient insomnia associatedwith stress, acute illness, or jet lag. Many patients with chronic insomnia, including primary insomniaand insomnia secondary to a variety of medical and psychiatric disorders, also benefit frompharmacotherapy. Relatively few individuals receive prescription medication to help them sleep, andthe majority use medication for a few nights to several weeks, as opposed to continuous use formonths or years. The hypnotics available on the U.S. market today are benzodiazepine receptor agonists(BZRAs). The BZRAs are efficacious in reducing sleep latency, increasing total sleep time,reducing awakenings, and improving sleep quality without the development of tolerance in studies aslong as 6 months. Side effects of the BZRAs are infrequent, dose-related, and related to the sedativeproperties of the drug. Sedating antidepressants are also frequently prescribed to promote sleep despiteinadequate data to support their efficacy for this indication and a greater potential for clinicallytroublesome side effects.