From the Guidelines
I strongly recommend considering eszopiclone as a treatment for sleep onset and sleep maintenance insomnia in adults, as suggested by the American Academy of Sleep Medicine clinical practice guideline 1. When it comes to managing anxiety and sleep issues after a loss, it's essential to prioritize medications that can address both concerns.
- Eszopiclone, a non-benzodiazepine hypnotic, is a suitable option for sleep onset and sleep maintenance insomnia, with recommended doses of 2 mg and 3 mg 1.
- Other options like zolpidem (5-10mg) or zaleplon (10 mg) could be used specifically for short-term sleep difficulties, but they may not address underlying anxiety.
- It's crucial to practice good sleep hygiene, including maintaining a consistent sleep schedule, avoiding screens before bed, creating a comfortable sleep environment, and limiting caffeine and alcohol.
- Grief can significantly disrupt sleep patterns and increase anxiety, so medications like eszopiclone work by promoting relaxation and sleep.
- Consult with a healthcare provider before starting any medication to ensure it's appropriate for your specific situation and medical history.
- The American College of Physicians guideline also suggests that cognitive behavioral therapy for insomnia (CBT-I) can be an effective treatment for insomnia, either alone or in combination with pharmacologic therapy 1.
From the FDA Drug Label
For insomnia due to anxiety or transient situational stress, a single daily dose of 2 mg to 4 mg may be given, usually at bedtime. The recommended dose of lorazepam for insomnia due to anxiety is 2 mg to 4 mg, taken at bedtime 2.
- The dose may vary depending on the patient's response and individual needs.
- It is essential to follow the prescribed dosage and administration instructions to minimize the risk of adverse effects.
- Lorazepam should be used with caution, especially in elderly or debilitated patients, and the dosage should be increased gradually as needed and tolerated.
From the Research
Anxiety Medication and Sleep
- After passing anxiety medication, individuals may still require assistance with sleep due to potential rebound insomnia or ongoing sleep disturbances 3.
- Zolpidem, a non-benzodiazepine hypnotic, is commonly used as an adjunctive treatment for insomnia, but it has a wide range of adverse effects, including an increased risk of falls, hip fractures, and complex behaviors such as sleepwalking and hallucinations 3.
- Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), are also used off-label for insomnia, but their efficacy and safety are uncertain due to limited evidence 4.
- Low-dose doxepin and trazodone may improve sleep quality compared to placebo, but the effects of SSRIs are uncertain, and there is a need for high-quality trials to determine the effectiveness and safety of antidepressants for insomnia 4.
Considerations for Sleep Medication
- When prescribing sleep medication, it is essential to consider the individual's physical and psychiatric risks, as well as the potential for adverse effects and interactions with other medications 3, 4.
- Cognitive-behavioral therapy (CBT) is a recommended approach for treating insomnia, and it can be used in conjunction with pharmacotherapy to minimize the needed dose and reduce the risk of adverse effects 3.
- The choice of sleep medication and dosage should be made on a case-by-case basis, taking into account the individual's specific needs and medical history 3, 4.