Pharmacotherapeutic Treatment Guidelines for Insomnia
- If have difficulties with sleep onset (Note: these agents not likely to be effective if patient has problem with sleep maintenance): zaleplon, zolpiden, triazolam, ramelteon
- If wake up in the middle of night (if have enough time for sleep ~4 hours) could use: zolpidem SL, zaleplon. This strategy might avoid nightly use of sleep agents and patient can use just if they have sporadic “middle of the night” awakenings.
- Avoid BZD: patients with severe pulmonary disease, elderly (for the most part), hx substance abuse
- Sedating antihistamines: Limited data but are used and helpful for some people. Caution with anticholinergic effects (especially older adults).
- Trazodone (25-100 mg), mirtazapine: Limited data but may be helpful for some people. Lower doses used for insomnia than what is used for depression