Skip to main content

Pharmacological Treatment of Insomnia

  • Chapter
  • First Online:
Primary Care Sleep Medicine

Abstract

Insomnia is an incredibly common complaint occasionally affecting more than 40 % of the population. Insomnia can be a primary diagnosis or secondary to associated sleep, psychiatric or medical illnesses that induce disturbed sleep or nighttime discomfort. Insomnia is most commonly treated with medications including drugs of abuse/misuse (ethanol and cannabis), over-the-counter preparations (type 1 antihistamines, herbal remedies, and nutritional supplements), and prescription hypnotics used as recommended or as based on sedative side-effect profiles. Many of theses agents have significant abuse potential and toxicity, and limited effectiveness when used to treat insomnia. The newer alpha 1 GABA-A active medications for insomnia are efficacious, minimally addictive, have minimal side effects, are nontoxic in overdose, and can be used long term without altering sleep structure. When appropriately utilized these newer medications are safe for use in most patients with insomnia.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Pagel JF, Kram J. Insomnia: differential diagnosis and current treatment approach. In: Monti JM, Pandi-Perumal SR, Mohler H, editors. GABA and sleep—molecular, functional and clinical aspects. Basil: Springer; 2010. p. 363–82.

    Google Scholar 

  2. Atack J. Anxioselective compounds acting at the GABA A receptor benzodiazepine binding site. Curr Drug Targets CNS Neurol Disord. 2003;2:213–32.

    Article  PubMed  CAS  Google Scholar 

  3. Lossignol D. Euthanasia: medications and medical procedures. Rev Med Brux. 2008;29:435–40.

    PubMed  CAS  Google Scholar 

  4. Ray WA, Griffen MR, Downey W. Benzodiazepines of long and short elimination half-life and the risk of hip fracture. JAMA. 1989;262:3303–7.

    Article  PubMed  CAS  Google Scholar 

  5. Ancoli-Israel S. Insomnia in the elderly: a review for the primary care practitioner. Sleep. 2000;23(S1):S23–30.

    PubMed  Google Scholar 

  6. Richardson GS. Managing insomnia in the primary care setting: raising the issues. Sleep. 2000;23(1):S9–12.

    PubMed  Google Scholar 

  7. Riemann D, Perlis ML. The treatment of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Med Rev. 2009;13(3):205–14.

    Article  PubMed  Google Scholar 

  8. George CFP. Perspectives in the management of insomnia in patients with chronic respiratory disorders. Sleep. 2000;23(S1):S31–5.

    PubMed  Google Scholar 

  9. Kessler RC, McGonagle KC, Zhao S. Epidemiology of psychiatric disorders. Arch Gen Psychiatry. 1994;51:8–19.

    Article  PubMed  CAS  Google Scholar 

  10. Pagel JF, Parnes BL. Medications for the treatment of sleep disorders: an overview. Prim Care Companion J Clin Psychiatry. 2001;3(3):118–25.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Krystal A, Walsh J, Laska E, Caron J, Amato D, Wessel T, Roth T. Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of randomized, double blind, placebo-controlled study in adults with chronic insomnia. Sleep. 2003;26(7):793–9.

    PubMed  Google Scholar 

  12. Parker I. The big sleep. New Yorker. 2013;9:50–63.

    Google Scholar 

  13. Vester JC, Spence DW, Shahid A, Pandi-Perumal SR, Roth T. Zopiclone as positive control in studies examining the residual effects of hypnotic drugs on driving ability. Curr Drug Saf. 2013;6:209–18.

    Article  Google Scholar 

  14. Sateia MJ, Doghramji K, Hauri PJ, Morin CM. Evaluation of chronic insomnia. Sleep. 2000;23(2):243–314.

    PubMed  CAS  Google Scholar 

  15. Pagel JF. Medication effects on sleep. In: Pandi-Perumal SR, Ruoti RR, Kramer M, editors. Sleep and psychosomatic medicine. Andover, Hampshire: Informa UK, Ltd; 2007. p. 109–24.

    Chapter  Google Scholar 

  16. Pagel JF. Medications that induce sleepiness. In: Lee-Chiong T, editor. Sleep a comprehensive handbook. Hoboken, NJ: Wiley; 2006. p. 175–82.

    Google Scholar 

  17. Jones BE, Jaffee SE, editors. Principles and practice of sleep medicine. 3rd ed. Philadelphia, PA: WB Saunders; 2000. p. 134–54. 1093–102.

    Google Scholar 

  18. Schwartz JH. Neurotransmitters. In: Kandel ER, Schwartz JH, Jessell TM, editors. Principles of neural science. 4th ed. New York, NY: McGraw Hill; 2000. p. 280–97.

    Google Scholar 

  19. Sateia MJ. Update on sleep and psychiatric disorders. Chest. 2009;135(5):1370–9.

    Article  PubMed  Google Scholar 

  20. Fava M, McCall WV, Krystal A, Wessel T, Ruben R, Caron J, Amato D, Roth T. Eszopiclone co-administered with fluoxetine in patients with insomnia coexisting with major depressive disorder. Biol Psycyiatry. 2006;59:1052–60.

    Article  CAS  Google Scholar 

  21. Settle EC. Antidepressant drugs: disturbing and potentially dangerous adverse effects. J Clin Psychiatry. 1998;59(S16):25–9.

    PubMed  CAS  Google Scholar 

  22. Pollack M, Kinrys G, Krystal A, McCall WV, Roth T, Schaefer K, Rubens R, Roach J, Huang H, Krishnan R. Eszopiclone coadministered with escitalopram in patients with insomnia and comorbid generalized anxiety disorder. Arch Gen Psychiatry. 2008;65:5.

    Article  Google Scholar 

  23. Lee-Chiong T, Pagel JF. Medication effects on sleep. In: Waldman SA, Terzic A, editors. Pharmacology and therapeutics—principles to practice. Philadelphia, PA: Saunders; 2009. p. 849–56.

    Google Scholar 

  24. Volz HP, Sturm Y. Antidepressant drugs and psychomotor performance. Neuropsychobiology. 1995;31:146–55.

    Article  PubMed  CAS  Google Scholar 

  25. Krystal AD. A compendium of placebo-controlled trials of the risks/benefits of pharmacological treatments for insomnia: the empirical basis for U. S. clinical practice. Sleep Med Rev. 2009;13:265–74.

    Article  PubMed  Google Scholar 

  26. Raskind MA, Peskind ER, Kanter ED, et al. Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study. Am J Psychiatry. 2003;160(2):371–3.

    Article  PubMed  Google Scholar 

  27. Krystal AD, Durrnace HH, Scharf M, Jochelson P, Rogowski R, Ludington E, Roth T. Efficacy and safety of doxepin 1 mg and 3 mg in a 12 week sleep laboratory and outpatient trial of elderly subjects with chronic primary insomnia. Sleep. 2013;33:1553–61.

    Google Scholar 

  28. Wirnow C, Gotter A, Cox C, Doran S, Tannenbaum P, Breslin M, et al. Promotion of sleep by suvorexant—a novel dual orexin receptor antagonist. J Neurogenet. 2013;25:52–61.

    Google Scholar 

  29. Pandi-Perumal SR, Spence DW, Verster JC, Srinivasan V, Brown GM, Cardinali DP, Hardeland R. Pharmacotherapy of insomnia with ramelteon: safety, efficacy and clinical applications. J Cent Nerv Syst Dis. 2013;3:51–65.

    Google Scholar 

  30. Stone BM, Turner C, Mills SL, Nicholson AN. Hypnotic activity of melatonin. Sleep. 2000;23(5):663–70.

    PubMed  CAS  Google Scholar 

  31. Mamelak M, Black J, Montplaisir J, Ristanovic R. A pilot study on the effects of sodium oxybate on sleep architecture and daytime alertness in narcolepsy. Sleep. 2004;27(7):1327–34.

    PubMed  Google Scholar 

  32. Pagel JF. The treatment of parasomnias. In: Kushida C, editor. Handbook of sleep disorders. London: Informa; 2008. p. 523–34.

    Google Scholar 

  33. Pagel JF. The synchronous electrophysiology of conscious states. Dreaming. 2012;22:173–91.

    Article  Google Scholar 

  34. Hart LL, Middleton RK, Schott WJ. Drug treatment for sleep apnea. DICP Ann Pharmacother. 1989;23:308–15.

    Google Scholar 

  35. O’Hanlon JF, Ramaekers JG. Antihistamine effects on actual driving performance in a standard driving test: a summary of Dutch experience. 1989–94. Allergy. 1995;50:234–42.

    Article  PubMed  Google Scholar 

  36. Stevinson C, Ernst E. Valerian for insomnia: a systematic review of randomized clinical trials. Sleep Med. 2000;1(2):91–9.

    Article  PubMed  Google Scholar 

  37. Brassington GS, King AC, Bliwise DL. Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64–99 years. J Am Geriatr Soc. 2000;48(10):1234–40.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. F. Pagel M.S., M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Pagel, J.F. (2014). Pharmacological Treatment of Insomnia. In: Pagel, J., Pandi-Perumal, S. (eds) Primary Care Sleep Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1185-1_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1185-1_9

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1184-4

  • Online ISBN: 978-1-4939-1185-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics