From the Guidelines
For insomnia, I strongly recommend starting with non-medication approaches and considering cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment, with pharmacologic therapy, such as eszopiclone (Lunesta, 1-3mg) or zolpidem (Ambien, 5-10mg), used only when necessary and for short periods. The most recent and highest quality study 1 advises against the use of benzodiazepines or trazodone for the treatment of chronic insomnia disorder due to their adverse effects and potential harms outweighing their benefits. Instead, the study recommends the use of nonbenzodiazepula BZRA, such as eszopiclone or zolpidem, at the lowest effective dose and for the shortest possible duration, with patients being counseled on the potential risks. Key points to consider when treating insomnia include:
- Starting with non-medication approaches, such as maintaining a consistent sleep schedule and avoiding screens before bed
- Considering CBT-I as the first-line treatment, as it has been shown to improve global outcomes and sleep outcomes in adults with chronic insomnia disorder 1
- Using pharmacologic therapy, such as eszopiclone or zolpidem, only when necessary and for short periods, due to the potential risks and harms associated with these medications
- Counseling patients on the potential risks and benefits of pharmacologic therapy, and monitoring them closely for adverse effects
- Addressing underlying conditions, such as sleep apnea, anxiety, or depression, that may be contributing to insomnia.
From the FDA Drug Label
Zolpidem tartrate tablets are indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation.
Zolpidem tartrate is used in adults for the short-term treatment of a sleep problem called insomnia (trouble falling asleep).
The recommended medication for insomnia (sleep disorders) is zolpidem tartrate. It is indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation.
- Key points:
- Zolpidem tartrate is used in adults for the short-term treatment of insomnia.
- It is not recommended for use in children under the age of 18 years.
- Zolpidem tartrate is a federally controlled substance (C-IV) because it can be abused or lead to dependence.
From the Research
Recommended Medications for Insomnia
The following medications are recommended for the treatment of insomnia:
- Benzodiazepine and nonbenzodiazepine sedative-hypnotic agents 3
- Ramelteon, a melatonin receptor agonist 3, 4
- Trazodone 3, 4, 5
- Sedating antihistamines 3
- Melatonin 4, 6
- Newer generation nonbenzodiazepines (eg, zolpidem, zaleplon) 7
- Sedating antidepressants such as mirtazapine, nefazodone, or tricyclic antidepressants 4
Non-Pharmacologic Options
Non-pharmacologic options for the treatment of insomnia include:
- Stimulus control 3
- Sleep hygiene education 3
- Sleep restriction 3
- Paradoxical intention 3
- Relaxation therapy 3
- Biofeedback 3
- Cognitive behavioral therapy (CBT) 3, 4, 7
- Cognitive behavioral therapy for insomnia (CBT-I) 7
Considerations for Treatment
When recommending treatment for insomnia, clinicians should consider patient-specific criteria such as: