From the Guidelines
Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for adults with chronic insomnia disorder, as it has been shown to improve sleep outcomes and reduce symptoms with minimal side effects 1.
Treatment Options for Insomnia
Treatment options for insomnia include both non-medication and medication approaches.
- Non-medication approaches include CBT-I, which consists of a combination of treatments such as cognitive therapy around sleep, behavioral interventions (such as sleep restriction and stimulus control), and education (such as sleep hygiene) 1.
- Medication approaches may be considered for short-term use in adults with chronic insomnia disorder in whom CBT-I alone was unsuccessful, using a shared decision-making approach to discuss the benefits, harms, and costs of pharmacological therapy 1.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I is a multicomponent therapy that includes:
- Sleep hygiene education: maintaining consistent sleep-wake times, avoiding caffeine and alcohol before bedtime, creating a comfortable sleep environment, and limiting screen time before bed.
- Stimulus control: associating the bed with sleep and removing distractions.
- Sleep restriction: limiting the amount of time spent in bed to improve sleep efficiency.
- Relaxation techniques: such as progressive muscle relaxation, deep breathing, and mindfulness meditation.
- Cognitive restructuring: identifying and challenging negative thoughts and beliefs about sleep.
Medication Options
If medication is necessary, short-term options include:
- Over-the-counter supplements like melatonin (0.5-5mg taken 1-2 hours before bedtime).
- Prescription medications such as zolpidem (5-10mg), eszopiclone (1-3mg), or temazepam (7.5-30mg) taken 30 minutes before bedtime for 2-4 weeks maximum to prevent dependence. For chronic insomnia, medications like trazodone (25-100mg), doxepin (3-6mg), or ramelteon (8mg) may be considered for longer use, although the evidence for these medications is weaker 1.
Benefits and Harms of Treatment Options
The benefits of CBT-I include improved sleep outcomes, reduced symptoms, and minimal side effects 1. The harms associated with CBT-I are likely to be mild, although some patients may experience symptoms of daytime fatigue and sleepiness, mood impairment, and cognitive difficulties during treatment 1. Medications may have more significant side effects, such as dependence, rebound insomnia, and next-day impairment, and should be used with caution and under close monitoring 1.
Conclusion is not allowed, so the answer just ends here.
From the FDA Drug Label
The clinical trials performed in support of efficacy were up to six months in duration. Zolpidem was evaluated in two controlled studies for the treatment of patients with chronic insomnia Ramelteon tablets are indicated for the treatment of insomnia characterized by difficulty with sleep onset.
The treatment options for patients with insomnia include:
- Zolpidem: a sedative/hypnotic drug that has been evaluated in two controlled studies for the treatment of patients with chronic insomnia 2
- Ramelteon: a sleep-promoting drug that is indicated for the treatment of insomnia characterized by difficulty with sleep onset 3 3 These medications have been shown to be effective in reducing sleep latency and improving sleep quality in patients with insomnia. However, it is essential to use these medications under the guidance of a healthcare professional and follow the recommended dosage and treatment duration to minimize potential side effects and risks.
From the Research
Treatment Options for Insomnia
The treatment options for patients with insomnia include:
- Cognitive Behavioral Therapy for Insomnia (CBT-I) 4, 5, 6, 7, which is a multi-component treatment that targets difficulties with initiating and/or maintaining sleep
- Sleep Restriction Therapy, Stimulus Control Therapy, Sleep Hygiene, and Cognitive Therapy, which are core components of CBT-I 4
- Relaxation techniques, which are also a key component of CBT-I 5, 7
- Pharmacotherapy, including newer generation nonbenzodiazepines (eg, zolpidem, zaleplon) and newer drugs active on targets other than the gamma-aminobutyric acid receptor 8
Effectiveness of CBT-I
CBT-I has been shown to be an effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes 6
- CBT-I produces results that are equivalent to sleep medication, with no side effects, fewer episodes of relapse, and a tendency for sleep to continue to improve long past the end of treatment 5
- CBT-I has been found to improve sleep onset latency, wake after sleep onset, total sleep time, and sleep efficiency 6
Barriers to Accessing CBT-I
Despite its effectiveness, CBT-I is underutilized due to a shortage of trained practitioners and lack of awareness among patients and healthcare providers 5, 7
- Physicians and healthcare providers can play an important role in educating their patients about CBT-I and recommending it as a first-line treatment for chronic insomnia 5