Management of insomnia: drug approach

Management of insomnia : drug approach The prescription of a hypnotic can be proposed in transient acute insomnia, but only for a short period and in this indication only. Chronic insomnia disorder is not an indication. The gold standard treatment for this disorder is cognitive and behavioral therapy. The prescription of a hypnotic should not be trivialized and is part of a short-term strategy. In the long term, hypnotics have poor effect on sleep duration, have side effects (excessive daytime sleepiness, impaired memory or attention, risk of falls and accidents), and have a high risk of dependence. The modalities of discontinuation of hypnotic treatments are to be anticipated with the patient as soon as the prescription is initiated. The discontinuation will be done by a gradual decrease of the doses to avoid a rebound effect at the end of the 4 weeks of prescriptions. In the context of chronic consumption of hypnotics, a strategy of discontinuation has to be proposed at any request for renewal of hypnotics. The decision must be discussed and considered with the patient during a shared decision-making process. Implementation requires precise evaluation of the severity of insomnia, the presence of a hypnotic dependence and the presence of a comorbid psychiatric disorder.