Perception by physicians that treatments for insomnia are ineffective or associated with risks Lack of discussion about sleep problems during patient consultationsīelief among patients and physicians that sleep complaints are not important Inadequate physician training in insomnia Six studies evaluated diphenhydramine.īarriers to recognition and treatment of insomnia Eighteen studies evaluated trazodone's efficacy on sleep endpoints, and in all except two ( 3, 4) of these the sample was limited to patients with depression- or antidepressant-induced insomnia. Eight nonbenzodiazepine studies, all of which included a placebo comparison, were identified. Of these, most were studies in which an active comparator was used and included patients with primary and secondary insomnia. In total, 41 studies were identified for approved benzodiazepines.
For articles on pharmacologic treatments the search terms used were "insomnia" and "flurazepam," "quazepam," "estazolam," "temazepam," "triazolam" (Food and Drug Administration -approved benzodiazepines), "zolpidem," and "zaleplon" (FDA-approved nonbenzodiazepines), as well as "trazodone" (commonly used for treating insomnia, although not FDA-approved for this purpose) and "diphenhydramine" (also commonly used for treating insomnia).įor nonpharmacologic treatments, a total of 11 papers were identified that discussed cognitive-behavioral, sleep-restriction, and sleep hygiene therapies. The search terms "insomnia" and "behavioral therapy" were used to search for articles on nonpharmacologic treatments. More research is necessary to determine the long-term effects of insomnia treatments.Ī PubMed search for English-language articles published between 19 that reported randomized controlled trials or active comparator trials was conducted. Current treatment options do not address the needs of difficult-to-treat patients with chronic insomnia, such as the elderly, and those with comorbid medical and psychiatric conditions. CONCLUSIONS: Insomnia is particularly challenging for clinicians because of the lack of guidelines and the small number of studies conducted in patient populations with behavioral and pharmacologic therapies. No conclusive evidence exists to favor either pharmacologic therapy or behavioral therapy.
However, pharmacologic therapy has a greater chance of producing side effects. Pharmacologic therapies have proven effective with improving wake time after sleep onset and sleep maintenance and reducing the number of nighttime awakenings. Nonpharmacologic therapies produce long-lasting and reliable changes among people with chronic insomnia and have minimal side effects. RESULTS: Evidence from epidemiologic studies, physician surveys, and clinical studies suggests that numerous patient and physician factors contribute to the fact that the needs of patients with insomnia remain unmet, including low reporting of insomnia by patients, limited physician training, and office-based time constraints, as well as misconceptions about the seriousness of insomnia, the advantages of treatment, and the risks associated with hypnotic use.
Search terms used were "insomnia," "behavioral therapy," and the generic names of agents commonly used to treat insomnia (the Food and Drug Administration-approved benzodiazepines and nonbenzodiazepines, trazodone, and over-the-counter agents). METHODS: A PubMed search for English-language articles covering randomized controlled trials published between 19 was conducted. OBJECTIVE: Insomnia has high prevalence rates and is associated with significant personal and socioeconomic burden, yet it remains largely underrecognized and inadequately treated.