1. Slideshow Pictures: Insomnia -- 10 Tips to Avoid Insomnia
2. Sleep Slideshow: Foods That Help or Harm Your Sleep
3. Sleep Quiz: Test Your Medical IQ

Medical Author:

Aparna Ranjan, MD

Coauthor:

Angela Gentili, MD

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

View Full Profile

Pharmacologic treatment usually provides rapid symptomatic relief.

Hypnotics (agents that promote sleep) and benzodiazepines (compounds with antianxiety, hypnotic, anticonvulsant, and muscle relaxant properties) are the mainstays of short-term treatment of primary insomnia.

Hypnotics

Basic principles for the treatment of insomnia include the following:

• Use the lowest effective dose.
• Use intermittent dosing (2 to 3 nights per week).
• Use for short term (2 to 3 weeks at a time).
• Discontinue after slow taper if the person has been taking it regularly.
• Use drugs with short and/or intermediate half-life to minimize daytime sedation.

*Zolpidem and Zaleplon are not structurally related to benzodiazepines.

Common side effects of hypnotics are as follows:

• Amnesia (total or partial inability to recall past experiences) and withdrawal effects may occur, especially with short-acting benzodiazepines (not with zolpidem and zaleplon).
• Residual daytime sedation with intermediate-acting and long-acting drugs may occur, depending on dosage.
• Rebound insomnia may occur with short-acting and intermediate-acting benzodiazepine after discontinuation.
• Short-acting agents are recommended for persons with difficulty falling asleep, while intermediate-acting drugs are indicated for problems with sleep maintenance.
• Avoid long-acting agents, especially in older people, because they cause daytime sedation, impair cognition, and, thereby, increase the risk of falls.

Not everyone should take hypnotic medications. Contraindications of hypnotics are as follows:

• Pregnancy
• Untreated obstructive sleep apnea
• History of substance abuse

Caution and close monitoring is needed in older people and in persons with hepatic, renal, or pulmonary disease.

Must Read Articles Related to Primary Insomnia

Disorders That Disrupt Sleep (Parasomnias) Parasomnias are disruptive sleep-related disorders. They are characterized by undesirable physical or verbal behaviors or experiences. Parasomnias occur in asso...learn more >>

Insomnia Insomnia affects most people at some point in their lifetime. Insomnia is actually a symptoms of a condition, disease, or situation. Non-medical treatment of in...learn more >>

Narcolepsy Narcolepsy is a sleep disorder that causes overwhelming and severe daytime sleepiness that often occurs at inappropriate times and places. The daytime sleep att...learn more >>

See the Entire Primary Insomnia Topic Guide »