What are precautions for use of sedative-hypnotics to treat insomnia?

Updated: Sep 11, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Answer

The following general precautions should be taken when sedative-hypnotics are used:

  • Start with a low dose, and maintain at the lowest effective dose

  • Avoid continued nightly use; encourage patients to use them only when truly necessary

  • Avoid using for more than 2-4 weeks if possible

  • Counsel patients to allow for at least 8 hours of sleep

  • Be aware that impairment can be present despite a feeling of being fully awake

  • When the problem is falling asleep, prefer hypnotics with a rapid onset of action (eg, zolpidem, zaleplon)

  • When the problem is staying asleep, consider a hypnotic with a slower rate of elimination (eg, temazepam, estazolam, flurazepam)

  • If the patient is depressed, consider an antidepressant with sedative properties (eg, trazodone, mirtazapine, amitriptyline) in preference to a hypnotic

  • Never use hypnotics with alcohol

  • Avoid using in pregnant patients

  • Avoid using benzodiazepines in patients with known or possible sleep apnea

  • Use lower doses in elderly patients


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