Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2007 Sep;22(9):1335-50.
doi: 10.1007/s11606-007-0251-z. Epub 2007 Jul 10.

The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs

Nina Buscemi  1 , Ben Vandermeer, Carol Friesen, Liza Bialy, Michelle Tubman, Maria Ospina, Terry P Klassen, Manisha Witmans
Affiliations
Meta-Analysis

The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs

Nina Buscemi et al. J Gen Intern Med. 2007 Sep.

Abstract

Background: Hypnotics have a role in the management of acute insomnia; however, the efficacy and safety of pharmacological interventions in the management of chronic insomnia is unclear.

Objective: The objective of this paper is to conduct a systematic review of the efficacy and safety of drug treatments for chronic insomnia in adults.

Data sources: Twenty-one electronic databases were searched, up to July 2006.

Study selection: Randomized double-blind, placebo-controlled trials were eligible. Quality was assessed using the Jadad scale. Data were pooled using the random effects model.

Data synthesis: One hundred and five studies were included in the review. Sleep onset latency, as measured by polysomnography, was significantly decreased for benzodiazepines (BDZ), (weighted mean difference: -10.0 minutes; 95% CI: -16.6, -3.4), non-benzodiazepines (non-BDZ) (-12.8 minutes; 95% CI: -16.9, -8.8) and antidepressants (ADP) (-7.0 minutes; 95% CI: -10.7, -3.3). Sleep onset latency assessed by sleep diaries was also improved (BDZ: -19.6 minutes; 95% CI: -23.9, -15.3; non-BDZ: -17.0 minutes; 95% CI: -20.0, -14.0; ADP: -12.2 minutes; 95% CI: -22.3, -2.2). Indirect comparisons between drug categories suggest BDZ and non-BDZ have a similar effect. All drug groups had a statistically significant higher risk of harm compared to placebo (BDZ: risk difference [RD]: 0.15; non-BDZ RD: 0.07; and ADP RD: 0.09), although the most commonly reported adverse events were minor. Indirect comparisons suggest that non-BDZ are safer than BDZ.

Conclusions: Benzodiazepines and non-benzodiazepines are effective treatments in the management of chronic insomnia, although they pose a risk of harm. There is also some evidence that antidepressants are effective and that they pose a risk of harm.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study selection and retrieval
Figure 2
Figure 2
Meta-graph of sleep onset latency (minutes) in adults with chronic insomnia: benzodiazepines versus placebo
Figure 3
Figure 3
Meta-graph of sleep onset latency (minutes) in adults with chronic insomnia: non-benzodiazepines versus placebo
Figure 4
Figure 4
Meta-graph of sleep onset latency (minutes) in adults with chronic insomnia: antidepressants versus placebo
See this image and copyright information in PMC

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '10737342', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/10737342/'}]}
    2. Sateia MJ, Doghramji K, Hauri P, Morin CM. Evaluation of chronic insomnia. An American Academy of Sleep Medicine Review. Sleep 2000;23:1–66. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/jama.262.11.1479', 'is_inner': False, 'url': 'https://doi.org/10.1001/jama.262.11.1479'}, {'type': 'PubMed', 'value': '2769898', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/2769898/'}]}
    2. Ford D, Kamerow D. Epidemiological study of sleep disturbances and psychiatric disorders: an opportunity for prevention. JAMA 1989;262:1479–84. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '9326825', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9326825/'}]}
    2. Simon GE, VonKorff M. Prevalence, burden, and treatment of insomnia in primary care. Am J Psychiatry. 1997;54:1417–23. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '12224841', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12224841/'}]}
    2. Leger D, Guilleminault C, Bader G, Levy E, Paillard M. Medical and socio-professional impact of insomnia. Sleep 2002;25:625–9. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '8723370', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/8723370/'}]}
    2. Ohayon M. Epidemiological study on insomnia in the general population. Sleep 1996;19(3 suppl):S7–15. - PubMed

MeSH terms