Pharmacologic management of insomnia.
Pharmacotherapy is indicated for many types of insomnia, most notably transient insomnia associated with stress, acute illness, or jet lag. Many patients with chronic insomnia, including primary insomnia and insomnia secondary to a variety of medical and psychiatric disorders, also benefit from pharmacotherapy. Relatively few individuals receive prescription medication to help them sleep, and the majority use medication for a few nights to several weeks, as opposed to continuous use for months 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 as long as 6 months. Side effects of the BZRAs are infrequent, dose-related, and related to the sedative properties of the drug. Sedating antidepressants are also frequently prescribed to promote sleep despite inadequate data to support their efficacy for this indication and a greater potential for clinically troublesome side effects.
Walsh
James K
JK
Sleep Medicine and Research Center, St. John's Mercy and St. Luke's Hospitals, Department of Psychiatry, Saint Louis University, St. Louis, MO, USA. walsjk@stlo.mercy.net
D000928:Antidepressive Agents / Q000627:therapeutic use*; D053961:Azabicyclo Compounds; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D058785:GABA-A Receptor Agonists; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D010879:Piperazines / Q000494:pharmacology / Q000627:therapeutic use; D012890:Sleep / Q000187:drug effects; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D016896:Treatment Outcome
D000928:Antidepressive Agents; D053961:Azabicyclo Compounds; D058785:GABA-A Receptor Agonists; D006993:Hypnotics and Sedatives; D010879:Piperazines; C515050:zopiclone; D001569:Benzodiazepines