Pharmacological and non-pharmacological treatments of insomnia

This chapter evaluates evidence-based treatment options for chronic insomnia. Insomnia is a common sleep disorder characterized by sleep onset and maintenance difficulties and daytime impairment such as reduced concentration and motivation. Cognitive behavioral therapy for insomnia (CBTI) is the first-line treatment for chronic primary and comorbid insomnia. CBTI comprises behavioral treatment (sleep restriction, stimulus control), relaxation, cognitive therapy, and sleep education. Its effects are of medium to large size and are stable up to two years after treatment. Benzodiazepines and benzodiazepine receptor agonists are equally effective for short-term treatment. However, because of their adverse effects, especially in the elderly, and their potential for tolerance and dependence, they are only recommended for a treatment period up to four weeks. Low doses of sedating antidepressants are commonly prescribed for treating chronic insomnia and have shown promising results in clinical trials. However, more research on their long-term efficacy and safety is needed.