What are general precautions regarding the use of sedative-hypnotics for insomnia?

Updated: Sep 11, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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The following general precautions should be taken when using sedative-hypnotics:

  • Therapy should be instituted with a low dose and maintained at the lowest effective dose

  • Continued nightly use should be avoided; patients should be encouraged to use them only when truly necessary

  • Use for more than 2-4 weeks should be avoided if possible

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

  • Impairment from sedative hypnotics can be present despite feeling fully awake

  • Hypnotics with a rapid onset of action, such as zolpidem or zaleplon, are preferable when the problem is falling asleep

  • If the problem is staying asleep, a hypnotic with a slower rate of elimination may be more appropriate (eg, temazepam, estazolam, flurazepam)

  • If the patient is depressed, an antidepressant with sedative properties, such as trazodone, mirtazapine, or amitriptyline, may be preferable to a hypnotic

  • Hypnotics should never be used with alcohol

  • In general, pregnancy is a contraindication

  • Benzodiazepines should be avoided in patients with known or possible sleep apnea

  • Lower doses should be used in elderly patients

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