Insomnia and its treatment

TLDR

Transient insomnia can become persistent if untreated, and benzodiazepine hypnotics—available in three US formulations with differing half‑lives, absorption, and interaction profiles—are the preferred short‑term treatment but may be ineffective or harmful for persistent insomnia. The authors seek to match hypnotic drug characteristics with patient needs to guide appropriate selection. They recommend selecting hypnotics by matching drug half‑life, absorption, and interaction profile to individual patient needs.

Abstract

Symptomatic treatment of transient insomnias is advisable, for without treatment these sleep disorders may become persistent. The drugs of choice are the benzodiazepine hypnotics, which have minimal side effects when used for short periods in properly selected patients. The three such drugs currently available in the United States differ enough in half-life, absorption rate, and potential for drug interactions that they cannot be used interchangeably. A sound selection matches the drug's characteristics with the patient's needs. Transient insomnias must be differentiated from persistent insomnias, which are more resistant to treatment. Hypnotic agents not only are more likely to be ineffective against persistent insomnias but also have greater potential for exacerbating a sleep-related breathing disorder, producing a drug-dependent insomnia, or contributing to drug misuse.