Chapter

Clinical Handbook of Insomnia

Part of the series Current Clinical Neurology pp 297-316

Date:

Pharmacological Treatment of Insomnia

  • Paula K. SchweitzerAffiliated withSleep Medicine and Research Center, St. Luke’s Hospital
  • , Denise Troy CurryAffiliated withSleep Medicine and Research Center, St. Luke’s Hospital
  • , Rhody D. EisensteinAffiliated withSleep Medicine and Research Center, St. Luke’s Hospital
  • , James K. WalshAffiliated withSleep Medicine and Research Center, St. Luke’s Hospital

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Abstract

Drugs currently used for the treatment of insomnia include benzodiazepine receptor agonists (BzRAs), a melatonin receptor agonist, sedating antidepressants, several atypical antipsychotics, sedating antihistamines, and unregulated substances such as valerian and melatonin. Among these compounds substantial evidence of efficacy exists only for the BzRAs and ramelteon; moreover, these drugs are among the safest of centrally acting drugs in common clinical use. Sufficient variability in BzRA pharmacokinetics provides clinicians with options to meet the needs of most patients. Efficacy and safety data of other drugs used to treat insomnia are currently inadequate to allow evidence-based treatment decisions. As the view of insomnia changes from a symptom of an underlying disorder to that of an independent, often chronic disorder, commonly comorbid with a variety of medical and psychiatric conditions, there is increased recognition of the need for long-term treatment. Further research on long-term use and use in comorbid illness is needed. Improvement in the management of insomnia will result from systematic research with these drugs, with drugs in development, and with novel therapeutic approached, such as combined therapies.

Keywords

Insomnia Pharmacotherapy Benzodiazepine receptor agonists Melatonin receptor agonists Antidepressants Melatonin Valerian