Sleep hygiene refers to environmental factors, dietary approaches, drugs, and a lack of required sleep facilitating approaches that can induce insomnia.
This approach avoids potential drug side effects and toxicities and has shown long-term persistence in treating chronic insomnia that can be superior to results obtained using drug therapies (Morin 2005). Insomnia can be treated without medications, using sleep hygiene combined with cognitive and behavioral therapies (CBT). Sleep behaviors must be addressed for any patient presenting with insomnia. Sleep hygiene and cognitive behavioral therapies Medications for treating insomnia are classified as hypnotics, sedatives, medications inducing sedation as a side effect, medications directed at the sleep-associated circadian neuroendocrine system, and agents utilized in treating insomnia-inducing sleep diagnoses such as restless leg syndrome (RLS) (Curry et al. While there are dozens of insomnia-associated sleep diagnoses, any medical or psychiatric disorder or environmental stress that produces nighttime discomfort is likely to induce insomnia. Chronic insomnia is significantly associated with a decrease in quality of life measures, the exacerbation of co-morbid diagnoses, and an increased likely-hood for developing mood disorders / de[ression (Sateia et al.
Chronic insomnia (> 3 months in duration) includes difficulty falling asleep, insufficient sleep, or perceived nonrestorative sleep producing daytime complaints of somnolence, fatigue, irritability, or difficulty concentrating and performing everyday tasks, and has a population prevalence of approximately 14 % (Hauri 2005 NIH State of the Science Conference Statement on Manifestations and Management of Chronic Insomnia in Adults Statement, Journal of Clinical Sleep Medicine 2005). Episodes of acute or transient insomnia each year affect > 80% of adults. Insomnia, defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, is a conspicuous problem in modern 24-h society (Sateia et al. Other pharmacological agents producing sedation (sedatives and agents used off-label for sedative side-effects) should be used cautiously for the treatment of insomnia due to the increased risk of next day sleepiness as well as for known toxicities and adverse side effects. These are the agents that should be exclusively classified as hypnotics and utilized to induce sleep when medications are required to treat the complaint of insomnia. Hypnotic medications with low toxicity, addictive potential, minimal next day sleepiness, and an otherwise benign side-effect profile can be utilized safely and effectively to treat and improve function and quality of life for patients suffering from insomnia.
Sedatives and other medications used off-label for sedative side-effects are a contributing factor to drug induced hypersomnolence, a factor in more than 30% of motor accident deaths. Except in individuals whose insomnia is secondary to circadian disturbance, mood disorder/depression and/or restless leg syndrome, there is minimal evidence supporting the efficacy of other medications used to treat insomnia despite their widespread use. In patients with comorbid insomnia the use of hypnotics can improve outcomes and potentially reduce morbidity and mortality associated with the use of more toxic medications. The newer GABA-effective hypnotics are the only medications with demonstrated effectiveness in treating chronic insomnia with the majority of evidence supporting treatment efficacy for cognitive-behavioral therapy and short acting GABA-receptor agonists. In this brief overview, medications used to treat insomnia such as hypnotics, sedatives, medications inducing sedation as a side effect, medications directed at the sleep-associated circadian neuroendocrine system, and agents utilized in treating insomnia-inducing sleep diagnoses such as restless leg syndrome are discussed. Insomnia is a conspicuous problem in modern 24 h society.
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