Behavioral and pharmacologic management options for insomnia.
Sleep and wakefulness are both active processes regulated by complex neural networks, the precise mechanisms of which are not yet fully understood. Patients with insomnia, particularly primary insomnia, often exhibit hyperarousal and may receive therapies to reduce wakefulness and promote sleep. Apart from standard sleep hygiene measures, physicians can offer patients behavioral therapy (if available) or pharmacologic therapy, or both. Both provide relief for insomnia symptoms; however, that relief appears durable on cessation of behavioral therapy only. Practice parameters for the treatment of insomnia are available for the use of behavioral therapy, but those for pharmacologic therapy are dated and do not reflect the current state of clinical practice. Hypnotic agents currently approved for use by the US Food and Drug Administration may be used for only 4 weeks and are limited by variable efficacy and concerns about safety profiles. This situation has prompted many physicians to prescribe antidepressants and other agents for their sedating properties, despite a paucity of efficacy and safety data in patients with insomnia. Of the hypnotic agents currently under clinical investigation, so far only eszopiclone has been studied in regard to efficacy over a prolonged period (6 months) with no evidence of significant tolerance. Although reports suggest that other hypnotics may also provide longer-term benefits, further research is needed to determine the optimal duration of treatment in chronic insomnia.
Benca
Ruth M
RM
Department of Psychiatry, University of Wisconsin Medical School, Madison, WI 53719-1176, USA. rbenca@med.wisc.edu
D000928:Antidepressive Agents / Q000627:therapeutic use; D053961:Azabicyclo Compounds / Q000627:therapeutic use; D001521:Behavior Therapy; D001569:Benzodiazepines / Q000627:therapeutic use; D000069582:Eszopiclone; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy
D000928:Antidepressive Agents; D053961:Azabicyclo Compounds; D006633:Histamine Antagonists; D006993:Hypnotics and Sedatives; D010879:Piperazines; D001569:Benzodiazepines; D000069582:Eszopiclone