Pharmacological treatment of insomnia

Introduction
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By Hrayr P Attarian MD

Dr. Attarian of Northwestern University in Chicago, Illinois, reviews all the pharmacological means for the treatment of insomnia. The review includes information on benzodiazepines, nonbenzodiazepine hypnotics, antidepressants, herbal supplements, and other over-the-counter medications. New updates include the potential role of controlled-release melatonin in primary insomnia, the role of valerian in insomnia in cancer survivors, and new data on objective evidence by PET scans on the ‘morning after’ impairment after a single nightly dose of diphenhydramine.

Key Points

  • Pharmacological treatment of insomnia is an important therapeutic field that can significantly improve health and quality of life in patients with problems falling or staying asleep.
  • So far, the most effective medications have been the GABAA agonists, either benzodiazepines or nonbenzodiazepine “z” drugs.
  • Certain antidepressants, melatonin agonists, and other non-GABA agonist medications may have a modest role in the treatment of insomnia.
  • Future medications will likely be orexin, 5-HT, and H1/H2 antagonists.
  • Zolpidem, although generally safe, can cause significant complex behaviors in sleep.