Insomnia: Therapeutic Approach

, MD, , MD, , Department of Psychiatry and Behavioral Medicine, University of Louisville School of Medicine, Louisville, Ky

South Med J. 2001;94(9) 

In This Article


Insomnia is common. Recognizing the specific etiology is important.[63] Transient and short-term insomnias are generally the result of stress and are evident in the history. These insomnias may resolve on their own or with life-style changes; however, when rapid relief is indicated, or if the sleep disturbance persists and is recurrent, a medication may help to restore normal sleep. Treatment is brief and dosage conservative ( Table 6 ).

Long-term insomnias may be a symptom of a medical, psychiatric, or primary sleep disorder. The evaluation focuses on causation. In considering therapeutic options, the priority should be treating the cause of the underlying condition that disturbs sleep rather than prescribing symptomatic pharmacotherapy; apply the appropriate, specific intervention for prostatic hypertrophy or congestive heart failure rather than just "sleeping pills." Antidepressant drugs are prescribed for depression. Sleep habit changes are recommended. Intermittent pharmacotherapy is an option for the patient with long-term insomnia, once other conditions are addressed. Long-term use is discouraged but may be acceptable and is widely practiced under physician observation. Elderly patients require lower dosages. The drugs of choice for symptomatic treatment of insomnia are shorter acting benzodiazepines, zolpidem, zaleplon, gabapentin, and sedating antidepressant medicines. Treatment of patients at risk for substance abuse focuses primarily on antidepressants, gabapentin, and possibly antihistamines.


The three duties of the physician are: First, the preservation of health; second, the cure of disease; and third, the prolongation of life.

Frances Bacon



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