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The Treatment of Primary Insomnia

Published online by Cambridge University Press:  07 November 2014

Andrew D. Krystal
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Extract

There are a several therapies available for the treatment of primary insomnia, most notably cognitive-behavioral therapy (CBT) and pharmacologic treatment. The benzodiazepines are a group of chemically related compounds represented by medications such as triazolam, temazepam, and lorazepam. Non-benzodiazepines, such as zaleplon, zolpidem extended-release (ER), eszopiclone and zopiclone, act via a mechanism similar to the benzodiazepines but have a different chemical structure. Also available is the melatonin receptor agonist, ramelteon, as well as several antihistamines such as diphenhydramine, doxylamine, hydroxyzine.

Medications, such as the antidepressants trazodone, mirtazapine, doxepin, and amitriptyline as well as the antipsychotics, quetiapine, olanzapine, and risperidone, have been used off-label for the treatment of insomnia. Patients often turn to alcohol, over-the-counter agents, and melatonin for relief of their sleep problems (Slide 1).

Given these treatment options, there are several questions faced in clinical practice concerning when to treat patients for insomnia, what treatments should be used, and how long treatment should continue. CBT is typically continued for a fixed length of time. Generally, the greater the functional impairment a person experiences, the more there is to be gained from treatment. The decision about whether to treat and which treatments should be used, should consider the risks and expected benefits of all treatment options. CBT for insomnia has relatively minimal risks, with the only downsides being cost, access, and convenience. CBT should always be a therapeutic option.

Type
Expert Panel Supplement
Information
CNS Spectrums , Volume 14 , Issue S13: The Sleep Cycle: A Four Stage Educational Initiative in Insomnia , December 2009 , pp. 6 - 10
Copyright
Copyright © Cambridge University Press 2009

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References

1.Krystal, A. A compendium of placebo-controlled trials of the risks/benefits of pharmacologic treatments for insomnia: The empirical basis for clinical practice. Sleep Med Rev. 2009;13(4):265–274.CrossRefGoogle Scholar
2.Edinger, JD, Wohlgemuth, WK, Radtke, RA, Marsh, GR, Quillian, RE. Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. JAMA. 2001;285:1856–1864.CrossRefGoogle ScholarPubMed
3.Morin, CM, Vallières, A, Guay, B et al. , Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. 2009;301(19):2005–2015.CrossRefGoogle ScholarPubMed
4.Krystal, AD, Walsh, JK, Laska, E et al. , Sustained efficacy of eszopiclone over six months of nightly treatment: Results of a randomized, double-blind, placebo controlled study in adults with chronic insomnia. Sleep. 2003;26:793–799.CrossRefGoogle Scholar
5.Walsh, JK, Krystal, AD, Amato, DA et al. , Nightly treatment of primary insomnia with eszopiclone for six months: Effect on sleep, quality of life and work limitations. Sleep. 2007;30(8):959–968.CrossRefGoogle ScholarPubMed
6.Ancoli-Israel, S, Richardson, GS et al. , Long-term use of sedative hypnotics in older patients with insomnia. Sleep Med. 2005;6(2):107–113. Epub 2005 Jan 26.CrossRefGoogle ScholarPubMed
7.Roth, T, Walsh, JK, Krystal, A, Wessel, T, Roehrs, TA. An evaluation of the efficacy and safety of eszopiclone over 12 months in patients with chronic primary insomnia. Sleep Med. 2005;6(6):487–595. Epub 2005 Oct 17.CrossRefGoogle ScholarPubMed
8.Krystal, AD, Erman, M, Zammit, GK, Soubrane, C, Roth, T; ZOLONG Study Group. Long-term efficacy and safety of zolpidem extended-release 12.5 mg, administered 3 to 7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Sleep. 2008;31(1):79–90.CrossRefGoogle ScholarPubMed