Insomnia nonpharmacologic

Patients with short-term or chronic insomnia should be evaluated after 1 week of therapy to assess for drug effectiveness, adverse events, and compliance with nonpharmacologic recommendations. Patients should be instructed to maintain a sleep diary, including a daily recording of awakenings, medications taken, naps, and an index of sleep quality. 

Although benzodiazepines, zolpidem, zaleplon, and eszopiclone are the mainstay of pharmacotherapy for insomnia, other sedating drugs, such as trazodone, diphenhydramine, or chloral hydrate, also may be used. Insomnia should first be addressed diagnostically, and in most cases, nonpharmacological interventions should be attempted before treatment with a hypnotic is instituted. Hypnotic agents should be administered in the lowest effective dose. Medications commonly prescribed for insomnia, along with their recom-... 

Chesson AL Jr, Anderson WM, Littner M, et al. Practice parameters for the nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep 1999 22 1128-1133. 

Morin C, Culbert JP, Schwartz SM. Nonpharmacological interventions for insomnia a meta-analysis of treatment efficacy. Am J Psychiatry 1994 151 1172-1180. 

Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Nonpharmacologic treatment of chronic insomnia. Sleep 1999 22(8) 1134—1156. 

Two meta-analyses on the efficacy of nonpharmacological interventions for insomnia have shown that SRT produces, along with stimulus control therapy, among the largest effect sizes on sleep onset latency and wake after sleep onset variables (3,4). However, SRT alone has been evaluated in significantly fewer studies than other interventions. Furthermore, results from meta-analyses have also shown that SRT produces a reduction of TST, particularly at posttreatment, with a rebound/gain at short-term follow-ups. Three treatment studies of late-life insomnia have directly compared the relative efficacy of SRT to other nonphar-... 

Sateia and Nowell [85] have proposed that long-term treatment with hypnotic medication could be implemented in patients with persistent insomnia not related to mental disorders, neurological diseases, medical conditions, or the effect of a substance of abuse or medication. In addition, nonpharmacological approaches have to be proven ineffective. Circumstances in which the long-term administration of hypnotic drugs must be discontinued include the development of tolerance and dose escalation, the occurrence of severe adverse events, and the diagnosis of newly developed disabilities. 

SAD can present in children of preschool to elementary school age. If the disorder is not treated, it can persist into adulthood and increase the risk of depression and substance abuse. CBT and social skills training are effective nonpharmacological therapies in children. Pharmacological evidence is limited to case studies or open-label trials. SSRIs are considered first-line therapy because of tolerability and effectiveness. Fluoxetine, fluvoxamine, sertraline, and paroxetine were effective in children with SAD. Headache, nausea, drowsiness, insomnia, jitteriness, and stomach aches were reported in children receiving SSRIs. 

Clinical situations commonly are encountered that require the use of hypnotics. Insomnia can be classified as primary (pathogenesis unknown) or secondary (from other causes). Secondary insomnia is more common and can be the result of situational stress, lifestyle habits, drugs, and psychiatric or medical disorders (1). There are effective nonpharmacological treatments for insomnia however, a need remains to use hypnotics on both a... 

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