Treatment of insomnia

Abstract

Insomnia is a major cause of distress, not only when people are trying to sleep but also because of daytime effects such as fatigue and poor work performance. This contribution covers the diagnosis of insomnia, and the distinction between insomnia and other sleep disorders. In many cases of insomnia, patients will respond to reassurance, education and measures to improve sleep habits. More severe cases may require treatment with an hypnotic drug, or possibly an antidepressant, or with proven psychological treatments, if available. When hypnotics are used, short-acting ones are preferred, as they minimize daytime carryover of sedation. The ‘z’ drugs (zopiclone, zolpidem, zaleplon) have benefits over the benzodiazepines in terms of faster onset of sleep, reduced propensity for tolerance and dependence, and less risk of misuse/diversion.