From the Guidelines
In medical rehabilitation settings, eszopiclone (1-3mg) is commonly used to help with sleep due to its efficacy in improving sleep outcomes, such as sleep onset latency, total sleep time, and wake after sleep onset, as shown in studies 1.
Medication Options
- Non-benzodiazepine hypnotics: zolpidem (5-10mg), zaleplon (5-20mg), or eszopiclone (1-3mg) are frequently used due to their fewer side effects and less risk of dependence.
- Benzodiazepines: lorazepam (0.5-2mg) or temazepam (15-30mg) are often prescribed for short-term use (typically 1-2 weeks) due to their sedative properties.
- Melatonin (1-5mg) is often used as a first-line option due to its favorable safety profile.
Considerations
- The choice of medication depends on the patient's specific sleep issue, medical history, and rehabilitation goals.
- Medications are usually combined with sleep hygiene education and cognitive behavioral therapy for insomnia to address the underlying causes of sleep disturbances.
- The approach helps prevent medication dependence while promoting long-term healthy sleep patterns during rehabilitation, as supported by studies 1.
Administration
- Medications are typically administered 30-60 minutes before bedtime.
- The patient's response to the medication and potential side effects should be closely monitored, as noted in studies 1.
From the FDA Drug Label
- 1 Controlled Clinical Trials Chronic Insomnia Three randomized, doubleblind trials in subjects with chronic insomnia employing polysomnography (PSG) were provided as objective support of ramelteon's effectiveness in sleep initiation Ramelteon reduced the average latency to persistent sleep at each of the time points when compared to placebo.
The medication used in medical rehab to help with sleep is ramelteon.
- Key benefits: Ramelteon reduces the average latency to persistent sleep.
- Dosage: The effective dose of ramelteon is 8 mg, as the 16 mg dose conferred no additional benefit for sleep initiation 2. No conclusion can be drawn about the use of ramelteon in a medical rehab setting, as the provided information does not explicitly address this context.
From the Research
Medications Used in Medical Rehab for Sleep
- Non-benzodiazepine hypnotics such as zolpidem, eszopiclone, zaleplon, and zopiclone are commonly used to treat insomnia 3, 4, 5
- Melatonin receptor agonists like ramelteon are also used for sleep onset insomnia 3, 6
- Other medications used for insomnia include suvorexant, a dual orexin receptor antagonist, and low-dose doxepin, an H1 antagonist 6, 7
- Lemborexant, a newer insomnia treatment, has shown efficacy in improving sleep outcomes with a safety profile similar to other insomnia treatments 7
Considerations for Medication Use
- Zolpidem has been associated with an increased risk of falls, hip fractures, and complex sleep-related behaviors 4, 5
- The use of Z-drugs in people living with dementia has been linked to a dose-dependent increase in fracture risk, but no other harms were detected 5
- The safety and efficacy of insomnia medications can vary depending on the individual, and decisions to prescribe should be made on a case-by-case basis, considering both physical and psychiatric risks 4, 6, 5