Modern standards for pharmacological treatment of insomnia

In clinical practice, insomnia can be classified as temporary and chronic. They differ in duration. Chronic insomnia lasts over 3 months, with symptoms occurring at least 3 times a week. Insomnia treatment standards were defined e.g. by the American Academy of Sleep Medicine in 2017. There are two treatment approaches. First, non-pharmacological methods should be applied, which are the basis of treatment and guarantee its sustained effect. These methods include abiding hygiene of sleep rules, sleep period limits, stimuli control and cognitive therapy. The second form of treatment is pharmacotherapy. It is based on benzodiazepine receptor agonists, which have replaced previous benzodiazepines. They have less side effects and lower addictive potential. This group includes zolpidem, zaleplon and zopiclone. Dosing regimen mainly depends on the form of insomnia being treated: temporary or chronic. Accidental and temporary insomnia should be treated with hypnotics without delay. It is advised to have a pill near one's bed and take it only when the patient waits too long to fall asleep after laying down or after an arousal. Such dosing scheme significantly reduces the risk of addiction and lowers the risk of transformation of insomnia into the chronic form. In chronic insomnia, when benzodiazepines are taken daily, 2 week period cannot be exceeded. Prolonged time is only allowed when using the drugs 2-3 times a week (or up to 10 times a month). Such pharmacotherapy guidelines are easier to tolerate, when the patient simultaneously complies with behavioural therapy. Besides that, a tricyclic antidepressant drug can also be used - doxepin. The list of inadvisable medications for the treatment of insomnia is composed of: trazodone, tiagabine, diphenhydramine, melatonin, tryptophan, valerian.