Psychiatric disorders (eg, depression, anxiety, posttraumatic stress disorder).Medical conditions (eg, obstructive sleep apnea, pulmonary disease, heart failure, chronic pain, restless legs syndrome, hyperthyroidism).1-5 The patient evaluation of comorbid conditions should exclude: Insomnia may be a condition in and of itself or a symptom of another underlying medical or behavioral condition. The diagnosis of insomnia is usually based on patient self-reporting. British Association for Psychopharmacology (2019) 5.Agency for Healthcare Research and Quality (AHRQ) (US Department of Health and Human Services) (2017) 3.American College of Physicians (ACP) (2016) 2.American Academy of Sleep Medicine (AASM) (2017) 1.Several groups have published guidelines for the management of insomnia, including: Insomnia can be treated with pharmacologic and nonpharmacologic approaches, individually or in combination. Guideline Recommendations for the Treatment of Insomnia

1-7 Older adults more often have difficulty maintaining sleep (wake time after sleep onset ), whereas younger adults report more difficulty falling asleep (sleep onset latency ). This article will discuss chronic insomnia primarily.Ĭhronic insomnia is associated with numerous adverse effects (AEs) on a person’s well-being, including fatigue, poor cognitive function, mood disturbance, and distress or interference with personal functioning. Insomnia can occur over either a short period of time (acute) or a longer period (chronic). Insomnia is pervasive in the United States and other Western societies. 1-5 It impairs daytime well-being and subjective abilities and functioning. Insomnia is a condition of unsatisfactory sleep in terms of sleep onset, sleep maintenance, or early waking. This article will review the available pharmacotherapeutic options for treating insomnia. However, several other agents are in later stages of development. To date, only suvorexant and lemborexant have been approved for the treatment of insomnia. More recently, orexin inhibitors have been introduced that may have fewer adverse effects, including the development of dependence. Benzodiazepines and nonbenzodiazepine GABA-A receptor agonists are the traditional medications used to treat insomnia. When cognitive behavioral therapy is not enough, medications can help patients overcome the barriers and learned behaviors that prevent a good night’s sleep. Cognitive behavioral therapy is the core treatment for insomnia. That is why I keep usage under 1 pill daily, when at all possible.Up to 10% of the US adult population will experience chronic insomnia, with women and elderly individuals at particularly high risk. You have to be careful with Xanax, since it is addictive. I believe anxiety/worry is the biggest source of my sleep issues, and that needs to always be addressed. Some nights the CD's allow me to fall asleep for hours, and if I awake, and have trouble falling back asleep, that is when I take a piece of my Xanax pill. One thing that helps greatly, is playing sleep meditation CD's at low volume, and having white noise from a fan etc. As my sources of anxiety have decreased, my sleep has improved. 25mg, which I tapered down to less than a pill a night, some nights only 1/4 of a pill, and still take it daily, anywhere from 1/4 to 3/4 pill per day. I tried trazadone for a couple weeks, but the horrible dry mouth/throat made me quit trazadone. Sounds like you are doing a lot of good things to get off the meds! I had very bad insomnia due to anxiety/worry, and certain physical ailments.

Trazodone for insomnia