From the Research
Hydroxyzine is not a recommended treatment for insomnia due to the lack of evidence supporting its effectiveness, and instead, cognitive behavioral therapy for insomnia (CBT-I) or other pharmacologic options such as low-dose doxepin, melatonin, ramelteon, and dual orexin receptor antagonists should be considered. When considering pharmacologic treatment, the most recent and highest quality study 1 suggests that low-dose doxepin, melatonin, ramelteon, and dual orexin receptor antagonists are preferred options for older adults. Some key points to consider when treating insomnia include:
- Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard for treatment of insomnia in young as well as older patients 1
- Pharmacologic options for older adults include low-dose doxepin, melatonin, ramelteon, and the dual orexin receptor antagonists 1
- Antihistamines such as doxylamine are effective for up to four weeks, but evidence for the use of other antihistamines to treat insomnia is generally lacking 2
- Sleep restriction therapy and stimulus control therapy are the most effective components of CBT-I 3
- CBT-I is an effective treatment for patients with insomnia and a comorbid mental disorder, especially depression, PTSD, and alcohol dependency 4