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Primary Insomnia (cont.)

What medications treat symptoms and cure primary insomnia?

Patient Comments

Treatment with medicine usually provides rapid symptomatic relief.

The mainstays of short-term treatment of primary insomnia include: hypnotics (agents that promote sleep) and benzodiazepines (compounds with antianxiety, hypnotic, anticonvulsant, and muscle relaxant properties).

Hypnotics for primary insomnia

Basic principles for the treatment of insomnia include the following:

  • Use the lowest effective dose of medication.
  • Use intermittent dosing (2 to 3 nights per week).
  • Use for a 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.
Commonly Used Hypnotics
AgentDosePeak Action
Long acting
Flurazepam (Dalmane)15 to 30 mg0.5 to 1 hr
Quazepam (Doral)7.5 to 15 mg2 hr
Intermediate acting
Eszopiclone (Lunesta)Nonelderly: 2 to 3 mg
Elderly: 1 to 2 mg
1 hr
Estazolam (ProSom)1 to 2 mg2 hr
Temazepam (Restoril)7.5 to 30 mg1.2 to 1.6 hr
Lorazepam (Ativan)0.5 to 2 g2 to 4 hr
Oxazepam (Serax)10 to 15 mg3 hr
Short acting
Triazolam (Halcion)0.125 to 0.5 mg1 to 2 hr
Zolpidem* (Ambien)5 to 10 mg1.6 hr
Zaleplon* (Sonata)5 to 10 mg0.9 to 1.5 hr

*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:

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

Belsomra (suvorexant)

Belsomra (suvorexant) is an orexin antagonist, a newer classification of insomnia medication. Orexion antagonists work by decreasing activity in the wake center of the brain and helping individuals transition to sleep. The other hypnotic medications typically act on the sleep promoting centers of the brain by attempting to increase activity in these areas. Dosage for Belsomra is 5 to 20 mg/2 hr. Belsomra is completely unrelated to both the benzodiazepine and non-benzodiazepine sedative-hypnotic drugs.

Side effects:

  • The primary side effect of this drug class is increased sleepiness during the day.
  • Overall it is considered relatively safe in early studies.
  • As with other sleep medications, caution should always be considered when other CNS depressants are being used.
  • At least 7 hours for sleep should be available after taking this medication, and any side effect such as abnormal behaviors during sleep, increased depressive symptoms, suicidal thoughts, daytime sleepiness, or breathing problems should be reported to your doctor.
Medically Reviewed by a Doctor on 8/26/2016
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Primary insomnia is sleeplessness that is not attributable to a medical, psychiatric, or environmental cause.

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