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
Review
. 2020 Jun;21(9):1035-1043.
doi: 10.1080/14656566.2020.1743265. Epub 2020 Mar 23.

Selecting a pharmacotherapy regimen for patients with chronic insomnia

Amanda B Hassinger  1   2 , Nikolas Bletnisky  1   2 , Rizwan Dudekula  1   2 , Ali A El-Solh  1   2   3
Affiliations
Review

Selecting a pharmacotherapy regimen for patients with chronic insomnia

Amanda B Hassinger et al. Expert Opin Pharmacother. 2020 Jun.

Abstract

Introduction: Chronic insomnia, whether it is primary or in combination with another medical or psychiatric disorder, is a prevalent condition associated with significant morbidity, reduced productivity, increased risk of accidents, and poor quality of life. Pharmacologic and behavioral treatments have equivalent efficacy with each having its own advantages and limitations.

Areas covered: The purpose of this perspective is to delineate the limitations encountered in implementing cognitive behavioral therapy (CBT) and to review the pharmacological treatments designed to target the different phenotypes of insomnia. The discussions address how to choose the optimal medication or combination thereof based on patients' characteristics, available medications, and the presence of comorbid conditions. Selective nonbenzodiazepine sedative 'Z-drug' hypnotics, melatonin receptor agonist-ramelteon, and low-dose doxepin are the agents of choice for treatment of primary and comorbid insomnia.

Expert opinion: A pharmacological intervention should be offered if cognitive behavioral therapy for insomnia is not available or has failed to achieve its goals. Increasing evidence of the significant adverse consequences of long-term benzodiazepines should limit the prescription of these agents to specific conditions. Testing novel dosing regimens with a combination of hypnotic classes augmented with CBT deserve further investigation.

Keywords: Pharmacotherapy; antidepressants; cognitive behavioral therapy; hypnotics; off-label.

PubMed Disclaimer

Conflict of interest statement

Declaration of Interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

References

    1. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97–111. - PubMed
    1. Ancoli-Israel S, Roth T. Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey I. Sleep. 1999;22(Suppl 2):S347–53. - PubMed
    1. Mallon L, Broman JE, Akerstedt T, et al. Insomnia in sweden: a population-based survey. Sleep Disord. 2014;2014:843126. - PMC - PubMed
    1. Neubauer DN, Pandi-Perumal SR, Spence DW, et al. Pharmacotherapy of Insomnia. J Cent Nerv Syst Dis. 2018;10:1179573518770672. - PMC - PubMed

    2. An up to date review on drug therapy for the management of insomnia.

    1. Collins PY, Patel V, Joestl SS, et al. Grand challenges in global mental health. Nature. 2011;475(7354):27–30. . - PMC - PubMed

MeSH terms