Current patterns and future directions in the treatment of insomnia.
BACKGROUND
Despite the high prevalence and the high burden associated with chronic insomnia, it remains largely unrecognized and often inadequately treated by physicians.


METHODS
A review was undertaken of the literature on barriers to both acute and chronic treatment of insomnia, as well as recent trials of pharmacologic and nonpharmacologic agents for insomnia.


RESULTS
Obstacles to appropriate treatment of the condition include outdated insomnia management guidelines, which have contributed to US Food and Drug Administration restrictions on longer-term prescription of hypnotic agents; lack of research demonstrating the benefit of treating insomnia; and fears of tolerance and withdrawal effects of long-term use of hypnotic agents, as well as an absence of longer-term, randomized, controlled, double-blind trials of existing agents used to treat insomnia.


CONCLUSIONS
There is evidence that improved sleep may improve outcome in some medical and psychiatric illnesses. Both behavioral and pharmacologic therapies have shown efficacy in chronic insomnia. In addition, a recent 6-month, randomized, controlled study has demonstrated that at least one agent may be safe and effective in longer-term use.
Winkelman
John
J
Sleep Disorders Program, Brigham and Women's Hospital, Sleep Health Center, Newton, MA 02459, USA. jwinkelman@sleephealth.com
Pies
Ronald
R
D001521:Behavior Therapy / Q000379:methods*; D001569:Benzodiazepines / Q000627:therapeutic use; D002908:Chronic Disease; D017281:Cost of Illness; D005544:Forecasting; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D004366:Nonprescription Drugs / Q000627:therapeutic use; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy*; D019966:Substance-Related Disorders / Q000209:etiology; D014196:Trazodone / Q000627:therapeutic use; D016896:Treatment Outcome
D001569:Benzodiazepines; D006634:Histamine H1 Antagonists; D006993:Hypnotics and Sedatives; D004366:Nonprescription Drugs; D017367:Selective Serotonin Reuptake Inhibitors; D014196:Trazodone