Therapeutic options in the treatment of insomnia

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.