Rational basis for the use of sleeping pills

The diagnosis and treatment of insomnia is a major clinical issue. This is because the complaint of insomnia is highly prevalent and because the various clinical and laboratory manifestations of insomnia are complex. In addition, insomnia involves both day and night. This paper attempts to provide a rational framework for the evaluation of insomnia and the use of sleeping pills. Insomnia is defined and described with special attention to differentiating the subjective complaint and the laboratory assessment of objective sleep parameters. Specific disorders causing or associated with sleep disturbance and the complaint of insomnia are described, and some data bearing on relative prevalence of specific disorders are presented. Consideration of sleeping pills involves the evaluation of hypnotic efficacy as a property of the medication on the one hand and the practical clinical application on the other. Properties of different hypnotics are reviewed, including factors that affect the use of hypnotics in clinical practice. It is concluded that the rational use of sleeping pills demands a systematic approach to the evaluation of the individual patient and a specific attempt to formulate individual treatment goals together with a knowledgeable consideration of the specific chemotherapeutic agent to be utilized.