Treating insomnia with medications

Abstract

Insomnia is a conspicuous problem in modern 24 h society. In this brief overview, medications used to treat insomnia such as hypnotics, sedatives, medications inducing sedation as a side effect, medications directed at the sleep-associated circadian neuroendocrine system, and agents utilized in treating insomnia-inducing sleep diagnoses such as restless leg syndrome are discussed. The newer GABA-effective hypnotics are the only medications with demonstrated effectiveness in treating chronic insomnia with the majority of evidence supporting treatment efficacy for cognitive-behavioral therapy and short acting GABA-receptor agonists. In patients with comorbid insomnia the use of hypnotics can improve outcomes and potentially reduce morbidity and mortality associated with the use of more toxic medications. Except in individuals whose insomnia is secondary to circadian disturbance, mood disorder/depression and/or restless leg syndrome , there is minimal evidence supporting the efficacy of other medications used to treat insomnia despite their widespread use. Sedatives and other medications used off-label for sedative side-effects are a contributing factor to drug induced hypersomnolence, a factor in more than 30% of motor accident deaths. Hypnotic medications with low toxicity, addictive potential, minimal next day sleepiness, and an otherwise benign side-effect profile can be utilized safely and effectively to treat and improve function and quality of life for patients suffering from insomnia. These are the agents that should be exclusively classified as hypnotics and utilized to induce sleep when medications are required to treat the complaint of insomnia. Other pharmacological agents producing sedation (sedatives and agents used off-label for sedative side-effects) should be used cautiously for the treatment of insomnia due to the increased risk of next day sleepiness as well as for known toxicities and adverse side effects.

Care of the Patient with a Sleep Disorder

“…For patients with persistent insomnia, chronic use with the newer hypnotics can be justified and is indicated if medication use leads to improvement in waking performance. These hypnotic agents are less likely to have deleterious side effects than diphenhydramine the most commonly used OTC treatment for insomnia contraindicated for use in anyone over 65 years of age (Table 4) [11].…”

Comparing the effect of aromatherapy with peppermint and lavender on the sleep quality of cardiac patients: a randomized controlled trial

“…Diazepam and nitrazepam, which belong to the family of benzodiazepines, are the most commonly used drugs (Fismer & Pilkington, 2012). Although these agents are efficient, they have several side effects, such as rebound anxiety, falls, and respiratory muscle depression (Chen et al, 2016;Wang et al, 2019;Uzun et al, 2010;Pagel et al, 2018). Use of these drugs also increases drug dependence and rebound insomnia and imposes higher costs on patients (Uzun et al, 2010;Pagel et al, 2018;Bioc et al, 2014;Plasencia et al, 2012;Surinkaew et al, 2011); consequently, it is necessary to use safer methods with minimal complications (Karadag et al, 2017).…”

“…Although these agents are efficient, they have several side effects, such as rebound anxiety, falls, and respiratory muscle depression (Chen et al, 2016;Wang et al, 2019;Uzun et al, 2010;Pagel et al, 2018). Use of these drugs also increases drug dependence and rebound insomnia and imposes higher costs on patients (Uzun et al, 2010;Pagel et al, 2018;Bioc et al, 2014;Plasencia et al, 2012;Surinkaew et al, 2011); consequently, it is necessary to use safer methods with minimal complications (Karadag et al, 2017). Non-pharmacological methods, such as sleep hygiene, cognitive behavioral therapies, and aromatherapy, are currently used for the management of sleep disorders (Pagel et al, 2018;Takeda et al, 2017).…”

“…Use of these drugs also increases drug dependence and rebound insomnia and imposes higher costs on patients (Uzun et al, 2010;Pagel et al, 2018;Bioc et al, 2014;Plasencia et al, 2012;Surinkaew et al, 2011); consequently, it is necessary to use safer methods with minimal complications (Karadag et al, 2017). Non-pharmacological methods, such as sleep hygiene, cognitive behavioral therapies, and aromatherapy, are currently used for the management of sleep disorders (Pagel et al, 2018;Takeda et al, 2017). However, sleep hygiene and cognitive behavioral therapies have some limitations, as they are costly and require special skills.…”

“…However, sleep hygiene and cognitive behavioral therapies have some limitations, as they are costly and require special skills. Also, they are rarely effective against acute and transient sleep disorders (Pagel et al, 2018). On the other hand, inhalation aromatherapy is relatively safe and easy to use (Fismer & Pilkington, 2012;Hassan et al, 2020;Bikmoradi et al, 2015).…”