Insomnia
- CBT-I is first-line for chronic insomnia
- Treat apnea, RLS, substances + circadian issues
- If drug needed: match to sleep complaint
- onset: zaleplon/zolpidem
- maintenance: DORA or low-dose doxepin
- Avoid routine antipsychotic use for insomnia
- BZD/Z-drug: falls + dependence risk
Use at a glance
- CBT-I is first-line for chronic insomnia
Choosing treatment
- If drug needed: match to sleep complaint
- onset: zaleplon/zolpidem
- maintenance: DORA or low-dose doxepin
Practical pearls
- Treat apnea, RLS, substances + circadian issues
Safety / pitfalls
- Avoid routine antipsychotic use for insomnia
- BZD/Z-drug: falls + dependence risk
Key points
- CBT-I 1st-line; add drug only if insomnia persists
- Sleep onset: short-acting BZRA (zaleplon, zolpidem); ramelteon
- Sleep maintenance: eszopiclone, zolpidem ER, low-dose doxepin, or orexin antagonist
- Middle-of-night awakening: low-dose SL zolpidem
Nonpharmacologic therapies
- CBT-I
- Stimulus control
- Sleep hygiene education
- Sleep restriction
- Relaxation training
- Cognitive therapy
- Scheduled awakening
- Limit bedtime screen time
Pearls
- Low-dose doxepin is not a controlled substance
Self-check
- How should an insomnia drug be selected if needed?
Match it to the sleep complaint. - What is first-line for chronic insomnia?
CBT-I.
Drugs used for this (25)
All clinical uses · Open Insomnia in the interactive console ↗