Indication and Limitation of Insomnia Treatment with Hypnotics

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  • Inoue Yuichi
    Department of Somnology, Tokyo Medical University Yoyogi Sleep Disorder Center

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  • ベンゾジアゼピン系薬剤と新規睡眠薬の適応と限界
  • ベンゾジアゼピンケイ ヤクザイ ト シンキ スイミンヤク ノ テキオウ ト ゲンカイ

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Abstract

<p>Although behavioral interventions are the mainstay of treatment, pharmacologic therapy may be necessary for some patients. A good understanding of the risks and benefits of insomnia medications is critical. Improvement of sleep hygiene and consolidation of circadian rhythm should be achieved before starting the pharmacological treatment. The so-called z-drugs (zolpidem, eszopiclone, and zopiclone) should be reserved for use if the non-pharmacological approaches are ineffective. For the general population with difficulty falling asleep, ramelteon, a melatonin receptor agonist, and the z-drugs can be considered. For those who have difficulty staying asleep, suvolexant, a dual orexin receptor antagonist, should be considered. Usage of high dose of benzodiazepines are not recommended because of their high abuse potential and the availability of better alternatives. Sedating antihistamines, antiepileptics, and atypical antipsychotics are not recommended unless they are used primarily to treat another condition. Persons with sleep apnea or chronic lung disease with nocturnal hypoxia should be evaluated by a sleepspecialist before sedating medications are prescribed.</p>

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