From the Guidelines
The most effective medications for treating insomnia include non-benzodiazepine hypnotics, such as zolpidem (Ambien) 5-10mg, eszopiclone (Lunesta) 1-3mg, or zaleplon (Sonata) 5-10mg, which are recommended for short-term use (2-4 weeks) due to their lower risk of dependence compared to traditional benzodiazepines. These medications work through various mechanisms, including enhancing GABA activity in the brain or regulating sleep-wake cycles. The choice of medication depends on the individual's specific symptoms and health status, and should ideally be used alongside cognitive behavioral therapy for insomnia (CBT-I) for best results and to prevent long-term medication dependence 1. Some patients may also benefit from sedating antidepressants like doxepin (3-6mg), particularly when depression coexists with insomnia 1. It is essential to note that benzodiazepines, such as temazepam (Restoril) 15-30mg or lorazepam (Ativan) 0.5-2mg, carry higher risks of dependence and tolerance, and should be used with caution 1. Additionally, antihistamines and antipsychotics are not recommended for treating chronic insomnia disorder due to their adverse effect profiles and limited evidence supporting their efficacy 1. Melatonin (1-5mg) represents a milder option with fewer side effects, but its effectiveness may vary depending on the individual 1. Ultimately, the goal of treatment is to improve sleep and alleviate distress or dysfunction caused by insomnia, and medications should be used judiciously and in conjunction with non-pharmacological therapies whenever possible. Key considerations include:
- Non-benzodiazepine hypnotics: zolpidem, eszopiclone, zaleplon
- Sedating antidepressants: doxepin
- Benzodiazepines: temazepam, lorazepam (use with caution)
- Melatonin: 1-5mg
- Antihistamines and antipsychotics: not recommended due to adverse effect profiles and limited evidence.
From the FDA Drug Label
Eszopiclone tablets are indicated for the treatment of insomnia. Ramelteon tablets are indicated for the treatment of insomnia characterized by difficulty with sleep onset. Zolpidem was evaluated in two controlled studies for the treatment of patients with chronic insomnia
The recommended medications for treating insomnia are:
- Eszopiclone (2)
- Zolpidem (3)
- Ramelteon (4)
From the Research
Medications for Insomnia
There are no specific medications recommended in the provided studies for treating insomnia. However, the studies suggest that non-pharmacologic approaches should be preferred in most cases due to the possible adverse effects of commonly used drugs to promote sleep 5.
Non-Pharmacologic Approaches
The recommended non-pharmacologic approaches for treating insomnia include:
- Cognitive Behavioral Therapy for Insomnia (CBT-I) 6, 7, 8, 9
- Exercise and relaxation techniques 5
- Complementary and alternative approaches, such as:
Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I is a multi-component treatment that targets difficulties with initiating and/or maintaining sleep and is delivered over the course of six to eight sessions 7. The core components of CBT-I include:
- Sleep Restriction Therapy
- Stimulus Control Therapy
- Sleep Hygiene
- Cognitive Therapy CBT-I has been shown to be an effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes and no adverse outcomes reported 6.