Rapid eye movement (REM) – when most dreaming occurs.There are two types of sleep that generally occur in a pattern of three-to-five cycles per night: Sleep is a basic human need and is critical to both physical and mental health. Sleep problems can both contribute to or exacerbate mental health conditions and can be a symptom of other mental health conditions.Ībout one-third of adults report insomnia symptoms and 6-10 percent meet the criteria for insomnia disorder.

Sleep difficulties are linked to both physical and emotional problems. Other sleep-wake disorders include obstructive sleep apnea, parasomnias, narcolepsy, and restless leg syndrome. There are several different types of sleep-wake disorders, of which insomnia is the most common. Sleep-wake disorders often occur along with medical conditions or other mental health conditions, such as depression, anxiety, or cognitive disorders. However, these concerning side effects have also been reported with the other 'Z-drugs' and, more rarely, benzodiazepines.Sleep disorders (or sleep-wake disorders) involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. Sleepwalking, sleep-driving, sleep-eating, sleep-sex, night terrors, and other abnormal sleep-related behaviors are most frequently associated with the use of zolpidem. There is an additive effect on psychomotor performance with concomitant CNS depressants or alcohol use. High doses of hypnotics with both short and long half-lives are more likely to cause symptoms of sedation and next-day impairment.Īll agents have the potential to cause significant cognitive impairment, including abnormal thinking and behavior changes, memory impairment, and central nervous system (CNS) depression. Rapid dose decreases or abrupt discontinuation can produce withdrawal symptoms, including rebound insomnia and anxiety.Īgents with long half-lives (eg, eszopiclone, temazepam) are associated with a greater risk for next-day impairment. Use of benzodiazepines and 'Z-drugs,' short- or long-term, has the potential to cause physical dependence.

Patients should not take a dose if they plan to get less than 7-8 hours of sleep, and middle-of-the-night dosing is not recommended. Ĭlinical pearls regarding dosing and potentially serious adverse side effects in the pharmacologic treatment of insomnia include :Īdminister on an empty stomach at least 30 minutes before bedtime administration with food can delay onset. The guidelines from the AASM also emphasize the importance of patient education and close monitoring to assess efficacy of treatment, risk factors for and emergence of adverse drug reactions, and the need for ongoing medication. While pharmacologic management has many advantages, a thorough understanding of the unique pharmacokinetic and pharmacodynamic properties of sleep aids is critical for the development of individual treatment plans to optimize therapeutic benefit and to ensure the safe use of these medications. *Little to no improvement in quality of sleep compared with placebo Summary of AASM Recommendations for the Pharmacologic Treatment of Insomnia Drug Patients should be re-evaluated periodically until symptoms have stabilized or resolved.įor all patients suffering from symptoms of insomnia, the initial management should include counseling and assessment of any precipitating or perpetuating factors, education about proper sleep hygiene and techniques, and management of contributing comorbidities. The goals of treatment are to improve both sleep quality and insomnia-related daytime impairment. More commonly, insomnia presents secondary to an acute or chronic medical condition (eg, obstructive sleep apnea, chronic obstructive pulmonary disease, allergies), medications (eg, decongestants, opioids, stimulants), substances (eg, caffeine, alcohol, nicotine), or other environmental factors and life changes. Primary insomnia may be idiopathic in nature or the result of conditioned sleep difficulty/heightened arousal (psychophysiologic insomnia). However, several types and subtypes of insomnia exist and are differentiated by etiology and pathophysiology. Insomnia is broadly defined as subjective difficulty with initiating or maintaining sleep that results in some form of daytime impairment.

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