Pharmacologic management of insomnia: past, present, and future.

Sleep Medicine and Research Center, St John's Mercy Medical Center and St Luke's Hospital, Chesterfield, MO 63017, USA.
Psychiatric Clinics of North America (Impact Factor: 2.13). 01/2007; 29(4):871-93; abstract vii-viii. DOI: 10.1016/j.psc.2006.09.006
Source: PubMed

ABSTRACT Views on the etiology and morbidities associated with insomnia are evolving and affect clinicians' approach to the pharmacologic management of insomnia. Currently, benzodiazepine receptor agonists (BzRAs) and a single melatonin receptor agonist are recognized as safe and efficacious hypnotics. Variability in BzRAs, pharmacokinetics, and manipulation of dose provide clinicians with options that meet the needs of most patients. Other drugs (eg, sedating antidepressants) also are used commonly in clinical practice to treat insomnia, but evidence is lacking to support this most cases. Improvement in managing insomnia will result from systematic research with these drugs, with drugs in development, and with novel uses, such as co-therapy.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To examine the speed and trajectory of changes in sleep/wake parameters during short-term treatment of insomnia with cognitive–behavioral therapy (CBT) alone versus CBT combined with medication; and to explore the relationship between early treatment response and post-treatment recovery status. Methods Participants were 160 adults with insomnia (mean age, 50.3 years; 97 women, 63 men) who underwent a six-week course of CBT, singly or combined with 10 mg zolpidem nightly. The main dependent variables were sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, and sleep quality, derived from sleep diaries completed daily by patients throughout the course of treatment. Results Participants treated with CBT plus medication exhibited faster sleep improvements as evidenced during the first week of treatment compared to those receiving CBT alone. Optimal sleep improvement was reached on average after only one week for the combined treatment compared to two to three weeks for CBT alone. Early treatment response did not reliably predict post-treatment recovery status. Conclusions Adding medication to CBT produces faster sleep improvement than CBT alone. However, the magnitude of early treatment response is not predictive of final response after the six-week therapy. Additional research is needed to examine mechanisms involved in this early treatment augmentation effect and its impact on long-term outcome.
    Sleep Medicine 06/2014; 15(6). DOI:10.1016/j.sleep.2014.02.004 · 3.10 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Insomnia is the difficulty to have a repairing and sufficient amount of sleep, and constitutes one of the most frequent disorders in geriatric patients (10-50%). Most of the cases are secondary or comorbid, being depression and anxiety the commonly associated disorders, although neurodegenerative diseases or other types of disorders can be present; that is why insomnia is linked as a symptom in different pathologies, sometimes underdiagnosed. Insomnia affects the social, physical and mental spheres of the patient. There is not a clear etiology and it is generally multifactorial, as its treatment should be. Diagnosis is based on the detailed clinical history and only a few patients with specific diseases should need laboratory studies. We have to be careful with the use of certain hypnotic drugs in the elderly patient, which can lead him to accidents or intoxication.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Sedative and hypnotic drugs could cure insomnia in a dependent manner, and traditional Chinese medicine has some superiority in treating insomnia.