What are the symptoms of insomnia?

From the Guidelines

Insomnia symptoms should be managed with cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment, as it is the most effective long-term treatment. For mild insomnia, start with sleep hygiene practices: maintain a consistent sleep schedule, avoid screens before bed, keep your bedroom dark and cool, limit caffeine and alcohol, and exercise regularly but not close to bedtime.

• Sleep hygiene practices include:
  • Maintaining a consistent sleep schedule
  • Avoiding screens before bed
  • Keeping the bedroom dark and cool
  • Limiting caffeine and alcohol
  • Exercising regularly but not close to bedtime For short-term medication options, consider over-the-counter melatonin (0.5-5mg taken 1-2 hours before bedtime) or diphenhydramine (25-50mg) 1. If these don't help, prescription medications like zolpidem (5-10mg), eszopiclone (1-3mg), or trazodone (25-100mg) may be appropriate for short-term use (generally 2-4 weeks) 1. Chronic insomnia often stems from underlying conditions like anxiety, depression, sleep apnea, or restless leg syndrome, which should be addressed. Persistent insomnia significantly impacts daily functioning, mood, and overall health by disrupting normal sleep architecture and hormonal regulation, so seeking professional help is important if symptoms persist beyond a few weeks 1.

From the FDA Drug Label

Eszopiclone tablets are used in adults for the treatment of a sleep problem called insomnia. Symptoms of insomnia include: trouble falling asleep, waking up often during the night

Eszopiclone tablets are used to treat insomnia symptoms, which include:

• trouble falling asleep
• waking up often during the night 2

From the Research

Insomnia Symptoms and Treatment

• Insomnia is a common sleep disorder characterized by difficulties initiating or maintaining sleep, or nonrestorative sleep, leading to daytime impairment 3, 4.
• The treatment of insomnia should involve a multi-disciplinary approach, focusing on implementing behavioral interventions, improving sleep hygiene, managing psychological stressors, hypnotic treatment, and pharmacological therapy 4.
• Cognitive Behavioral Therapy for Insomnia (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 3.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

• CBT-I is a non-pharmacological intervention that has been shown to be effective in treating insomnia, with a large evidence base and recent recommendation as the first line intervention for insomnia 3.
• Core components of CBT-I include Sleep Restriction Therapy, Stimulus Control Therapy, Sleep Hygiene, and Cognitive Therapy 3.
• CBT-I can be delivered alone or in combination with medication, such as zolpidem, and has been shown to produce durable sleep improvements up to two years after completion of treatment 5.

Pharmacological Treatment of Insomnia

• Zolpidem is a non-benzodiazepine hypnotic that is commonly used to treat insomnia, but has been associated with adverse effects such as falls, hip fractures, and complex behaviors 4.
• The use of zolpidem in elderly patients should be approached with caution, and the dose should be adjusted to account for their slower drug metabolism 4, 6.
• Other pharmacological options for treating insomnia include benzodiazepines, non-benzodiazepine receptor agonists, suvorexant, ramelteon, and sedating antidepressants, but these should be used with caution and under the guidance of a healthcare professional 6, 7.

Long-Term Management of Insomnia

• Long-term use of sedative-hypnotics for insomnia lacks an evidence base and has traditionally been discouraged due to concerns about potential adverse drug effects 7.
• CBT-I and other non-pharmacological interventions are recommended as the first line treatment for insomnia, with pharmacological options used as needed and under the guidance of a healthcare professional 3, 6, 7.
• More research is needed to evaluate the long-term effects of treatment and the most appropriate management strategy for elderly persons with chronic insomnia 7.