![]() 8,10 Since the side effects are mostly dose related, patients should be maintained on the lowest effective dose for the shortest period of time that is necessary to treat the insomnia complaints. Long half-life agents also increase the risk for poor outcomes in elderly patients, including increased risk of drug accumulation, falls, and confusion. 9 Subsequent daytime hangover is particularly problematic when using benzodiazepines with long durations of action (e.g., flurazepam ). Other common adverse effects include drowsiness, dizziness, and headache. 10 These may include changes in sleep architecture (mainly shortened time in both deep and rapid eye movement sleep and increased time in intermediate sleep), subsequent daytime hangover, anterograde amnesia, mental status changes, psychomotor impairment, rebound insomnia, and withdrawal symptoms upon discontinuation. 9īenzodiazepines are safe and effective for the treatment of insomnia when used short-term at recommended doses however, due to their mechanism of action, a number of adverse effects can occur. Recommended doses, onset and duration of action, half-life, and insomnia indication for these drugs are outlined in TABLE 1. There are five benzodiazepines that are FDA approved for the treatment of insomnia, and all are schedule IV controlled substances. Benzodiazepines affect sleep by increasing total sleep time and shortening sleep latency. ![]() These agents bind to gamma-aminobutyric acid (GABA) receptors in the central nervous system (CNS), causing inhibition of neuronal excitation. 7,8 Pharmacologic options will be discussed here, as well as concerns surrounding the use of these agents that must be considered when determining the optimal management for an individual with insomnia.īenzodiazepines are one of the most widely used drug classes for the short-term treatment of insomnia. Proper management of chronic insomnia includes the identification of the underlying medical, psychiatric, and psychosocial factors, as well as utilization of nonpharmacologic and pharmacologic treatment. Health care providers must carefully assess those at greatest risk for insomnia, including the elderly, females, shift workers, individuals with comorbid medical and psychiatric conditions, and those with less education. 5,6 Due to the widespread impact of insomnia, adequate identification and management of this condition are critical. Examples include increased use of health care resources, reduced quality of life, effects on physical health, impairment in family and social relationships, and the possibility of emergent psychiatric conditions. 4 This increase is quite alarming, especially considering the myriad negative consequences associated with insomnia. 1 While only 10% of the adult population experiences chronic insomnia, 2,3 in the past 8 years the number of individuals who sleep less than 6 hours a night has risen 13%. While estimates vary depending on the definition of insomnia utilized, an estimated 70 million Americans live with a chronic sleep disorder, which is associated with an economic burden greater than $100 billion in direct and indirect costs every year in the United States.
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