![]() Zaleplon improves sleep quality but likely has no effect on TST. Zolpidem improves global outcomes, sleep latency, TST, and sleep quality it may reduce WASO. In the general adult population: Eszopiclone improves global outcomes, SOL, and total sleep time (TST) as well as reduces WASO.The AHRQ does not make recommendations but notes the following from a systematic review of 169 randomized controlled trials and 12 observational studies 3: The AASM recommends against using trazodone, tiagabine, diphenhydramine, melatonin, tryptophan, or valerian for either sleep-onset or sleep-maintenance insomnia. For sleep onset insomnia: eszopiclone, zaleplon, zolpidem, triazolam, temazepam, ramelteon.For sleep maintenance insomnia: suvorexant, eszopiclone, zolpidem, temazepam, doxepin.The AASM recommends the following pharmacotherapies 1: The ACP does not recommend specific pharmacotherapy, but rather that clinicians use a shared decision-making approach when determining whether to add pharmacotherapy in adults with chronic insomnia disorder in whom cognitive behavioral therapy for insomnia (CBTI) alone was unsuccessful. If still no improvement, introduce alternative therapies (eg, valerian, melatonin).If still no improvement, combine CBT with evidence-based pharmacology. ![]() Reevaluate, especially for occult comorbid disorders. If still no improvement, reconsider diagnosis.If no effect, consider adding additional nonpharmacologic modalities.Initiate treatment with cognitive behavioral therapy (CBT) with/without relaxation therapy.Optimize treatment for any comorbid disorders. ![]() However, they follow a general approach 1-5,8: The guidelines vary in their recommendations of specific pharmacologic treatments. Questionnaires, at-home sleep logs, and actigraphy can all be helpful tools for the assessment of insomnia in the absence of other apparent etiologies. For instance, insomnia may lead to anxiety about insomnia, which could further exacerbate sleep fragmentation. Many individuals may experience insomnia and comorbid disorder(s) concurrently.
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