title: Pharmacotherapy Treatment Options for Insomnia: A Primer for Clinicians.
abstract: Insomnia is a prevalent disorder with deleterious effects such as decreased quality of life, and a predisposition to a number of psychiatric disorders. Fortunately, numerous approved hypnotic treatments are available. This report reviews the state of the art of pharmacotherapy with a reference to cognitive behavioral therapy for insomnia (CBT-I) as well. It provides the clinician with a guide to all the Food and Drug Administration (FDA) approved hypnotics (benzodiazepines, nonbenzodiazepines, ramelteon, low dose sinequan, and suvorexant) including potential side effects. Frequently, chronic insomnia lasts longer than 2 years. Cognizant of this and as a result of longer-term studies, the FDA has approved all hypnotics since 2005 without restricting the duration of use. Our manuscript also reviews off-label hypnotics (sedating antidepressants, atypical antipsychotics, anticonvulsants and antihistamines) which in reality, are more often prescribed than approved hypnotics. The choice of which hypnotic to choose is discussed partially being based on which segment of sleep is disturbed and whether co-morbid illnesses exist. Lastly, we discuss recent label changes required by the FDA inserting a warning about "sleep-related complex behaviors", e.g., sleep-driving for all hypnotics. In addition, we discuss FDA mandated dose reductions for most zolpidem preparations in women due to high zolpidem levels in the morning hours potentially causing daytime carry-over effects.
authors.affiliation: Albert Einstein College of Medicine/Montefiore Medical Center, Department of Psychiatry &amp; Behavioral Science, Bronx, NY 10467, USA. asnisarts@aol.com.|The Anxiety and Depression Clinic, Bronx, NY 10570, USA. asnisarts@aol.com.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Asnis
authors.affiliation: The Anxiety and Depression Clinic, Bronx, NY 10570, USA. manju.thomas3@gmail.com.
authors.forename: Manju
authors.initials: M
authors.lastname: Thomas
authors.affiliation: The Anxiety and Depression Clinic, Bronx, NY 10570, USA. mahg96@aol.com.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Henderson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000592:standards / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D014481:United States; D014486:United States Food and Drug Administration; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives
keywords: guidelines; hypnotics; insomnia; treatment options