From the Guidelines
I strongly recommend trying cognitive behavioral therapy for insomnia (CBT-I) as your next step, which is highly effective without medication side effects and addresses the underlying causes of sleep problems by changing sleep habits and thoughts that disrupt sleep, as supported by the American College of Physicians guideline 1. If you still need medication, we could consider low-dose doxepin (3-6mg), ramelteon, or extended-release melatonin, which generally have fewer side effects than Ambien while still potentially helping with sleep, according to the American Academy of Sleep Medicine clinical practice guideline 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Next Steps for Insomnia Treatment
- Considering the patient has already tried various medications, including belsomra, quviviq, trazadone, hydroxyzine, and ambien, with ambien being the only effective one but with undesirable side effects, the next step could be to explore non-pharmacological treatments.
- The patient may benefit from Cognitive Behavioral Therapy for Insomnia (CBTi), which has been shown to be an effective treatment for insomnia, with studies such as 2, 3, and 4 demonstrating its efficacy in improving sleep quality and reducing symptoms of insomnia.