From the Guidelines
The recommended treatment for insomnia begins with cognitive behavioral therapy for insomnia (CBT-I), which is considered first-line treatment. This approach includes sleep hygiene practices such as maintaining a consistent sleep schedule, creating a comfortable sleep environment, avoiding caffeine and alcohol before bedtime, and limiting screen time. If these non-pharmacological approaches are insufficient, short-term medication may be considered. Common medications include over-the-counter options like melatonin or prescription medications such as zolpidem, eszopiclone, or trazodone taken shortly before bedtime. Benzodiazepines like temazepam may be prescribed but are generally limited to 2-4 weeks due to dependency risks. Medications should be used at the lowest effective dose and for the shortest duration possible. The underlying cause of insomnia should also be addressed, whether it's stress, anxiety, depression, or a medical condition. This multi-faceted approach is recommended because insomnia often involves both psychological and physiological factors, and addressing both components leads to more sustainable improvement in sleep quality, as supported by the American Academy of Sleep Medicine 1 and the American College of Physicians 1.
Some key points to consider when treating insomnia include:
- CBT-I is a multicomponent intervention that includes sleep restriction therapy, stimulus control, and cognitive therapy, and is the most widely evaluated delivery method for insomnia treatment 1.
- The use of CBT-I has been shown to improve global outcomes, including increased remission and treatment response, and reduced insomnia severity index (ISI) and Pittsburgh Sleep Quality Index (PSQI) scores compared to controls 1.
- Pharmacological treatments, such as eszopiclone and zolpidem, may be considered for short-term use, but should be used with caution due to the risk of dependency and other adverse effects 1.
- The treatment of insomnia should be individualized, taking into account the patient's preferences, values, and comorbid medical and psychiatric conditions 1.
Overall, the treatment of insomnia requires a comprehensive approach that addresses both psychological and physiological factors, and should be guided by the latest evidence-based recommendations, such as those provided by the American Academy of Sleep Medicine 1 and the American College of Physicians 1.
From the FDA Drug Label
Zolpidem tartrate tablets are indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation. The recommended treatment for insomnia is zolpidem tartrate tablets for the short-term treatment of insomnia characterized by difficulties with sleep initiation 2.
- The treatment is indicated for short-term use.
- Zolpidem tartrate tablets have been shown to decrease sleep latency for up to 35 days in controlled clinical studies. Key points to consider:
- Short-term treatment
- Difficulties with sleep initiation
- Zolpidem tartrate tablets 2
From the Research
Recommended Treatment for Insomnia
The recommended treatment for insomnia is cognitive-behavioral therapy for insomnia (CBT-I) [(3,4,5,6,7)]. This non-pharmacological approach has been shown to be effective in managing insomnia in a wide range of populations.
Key Components of CBT-I
The key components of CBT-I include:
- Sleep consolidation [(4,5)]
- Stimulus control [(4,5)]
- Cognitive restructuring 4
- Sleep hygiene [(4,5)]
- Relaxation techniques 4
Benefits of CBT-I
The benefits of CBT-I include:
- Equivalent results to sleep medication 4
- No side effects 4
- Fewer episodes of relapse 4
- Long-term improvements in sleep 4
Implementation of CBT-I
CBT-I can be implemented in various settings and can be adapted for different age groups 6. It is recommended that CBT-I be delivered over the course of six to eight sessions 5.
Other Non-Pharmacological Approaches
Other non-pharmacological approaches, such as sleep restriction therapy, stimulus control therapy, and relaxation training, may also be recommended in the treatment of chronic insomnia 3. However, CBT-I is considered the standard of care 3.