![]() Recently published American Academy of Sleep Medicine (AASM) guidelines provide support for the use of long-term pharmacologic modalities to treat insomnia. ![]() ♦ Sleep-disordered breathing may be common in patients with treatment-resistant insomnia. Indeed, for years trazodone 13 was the single most-prescribed medication for sleep, and although there is scant evidence describing the efficacy of antidepressants for insomnia, there can be no doubt that these drugs are often prescribed for the combination of insomnia and depression. Interestingly, these prescription medications may include standard sedatives as well as sedating antidepressants. 12 However, in clinical settings, it is not unusual for various subgroups of patients, for example psychiatric patients, to rely on the regular, long-term use of prescription medications for sleep. Traditional standards indicate prescribed medication for acute, transient, or situational insomnia, and the prescribing instructions may recommend nightly use for a few weeks or a few times per week for longer intervals. In contrast, pharmacotherapy for insomnia is well established throughout all fields of medicine. ![]() In these environments, insomnia patients may receive exposure to evidenced-based treatments for unwanted sleeplessness, 8, 9, 11 for example, prescription medications for sleep and cognitive-behavioral therapies (CBTs).Įvidence for CBT as the ideal first-line treatment for insomnia is persuasive and substantial, but the lack of behavioral sleep medicine specialists both at sleep medical centers and in the medical community at large 8 has limited the application of this therapeutic option. This type of health care encounter most frequently involves primary care physicians or mental health providers, including psychiatrists, psychologists, and other therapists. ![]() And, in a progression through these approaches, albeit in no fixed order, some insomnia patients broach the issue with a physician or other provider with whom they regularly interact. 8 – 10 There is often overlap among these 4 pathways. Initially, insomnia patients navigate through 4 common pathways: no discernible treatment, over-the-counter sleep aids, 5, 6 substances or alcohol at bedtime, 6, 7 and basic sleep hygiene instructions obtained through various media or from primary care providers and educators. Chronic insomnia is a common complaint in the general population as well as in various subpopulations such as the elderly, 1 psychiatric patients, 2, 3 and shift workers 4 however, longitudinal data are lacking on their long-term treatment course. ![]()
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