Therapeutic Options in the Treatment of Insomnia
J Clin Psychiatry 2005;66(suppl 9):18-23
© Copyright 2014 Physicians Postgraduate Press, Inc.
Pharmacologic and nonpharmacologic therapies both have roles in the treatment of insomnia. The
benzodiazepines, when first introduced, were a major improvement over earlier treatments for insomnia
in terms of their safety and efficacy. Since then, the nonbenzodiazepine benzodiazepine receptor
agonists have been developed, which have provided advantages over the older medications and are
currently first-line medication treatment for insomnia. Although antidepressants, antipsychotics, and
anticonvulsants are often prescribed for the treatment of insomnia, they are not approved by the U.S.
Food and Drug Administration for this indication and have side effects that are sometimes severe.
New types of medications that have different modes of action from the benzodiazepine receptor agonists
are now being developed, and one, a selective melatonin receptor agonist, has recently been approved
for treatment of insomnia. Nonpharmacologic therapies can also help patients learn how to fall
asleep faster and improve sleep quality. It is important for physicians to teach patients good sleep hygiene
as part of their treatment. Cognitive-behavioral therapy is effective in the treatment of insomnia,
alone and in combination with pharmacotherapy, but finding a qualified provider can be difficult and
the patient must be willing to take the time to learn the therapies and wait for them to show effect.