Pharmacological treatment of insomnia

In the pharmacological treatment of insomnia, benzodiazepine receptor agonists are drugs of first choice; however, there are several alternatives, e. g. sedating antidepressants and neuroleptics. When choosing an appropriate hypnotic, several factors have to be considered, such as severity and phenomenology of insomnia, comorbidity and age. There is a large consensus among experts regarding the indications for treatment of insomnia with hypnotics. In general, a restriction of treatment to a couple of weeks is recommended. In few exceptional cases only, a long-term continuous treatment appears justified. There are some general rules for performing and discontinuing treatment with hypnotics. Especially after long-term treatment with benzodiazepine receptor agonists, the dosage should be decreased slowly before definitely discontinuing treatment. If needed, other sedating drugs should be given during this period.