Overall, the evidence base for CBT-I is stronger than for drugs. Because prolonged use causes tolerance and dependence, benzodiazepines are best for treating sleep disorders in the short term. In a randomized, double-blind, placebo-controlled trial, delayed-release melatonin was associated with improvements in sleep and diurnal parameters, including sleep latency, sleep quality, and morning alertness, in adults with primary insomnia after three weeks of treatment. Doxepin is FDA-approved to treat sleep disorders characterized by difficulty maintaining sleep. However, other sedative TCAs (such as amitriptyline, nortriptyline, and imipramine) have not been approved to treat patients with sleep disorders.
Benzodiazepines are generally avoided to treat sleep disorders, particularly in elderly patients and individuals with drug use disorders.
What is the first drug treatment for sleep disorders?
In general, Z-hypnotics (zolpidem, zaleplon, eszopiclone) should be selected as first-line pharmacological therapy for most patients. Proper treatment for chronic insomnia includes identifying the underlying medical, psychiatric, and psychosocial factors and seeking nonpharmacological and pharmacological treatments. Before starting treatment for sleep disorders, other medical or psychiatric conditions, as well as medications that may contribute to sleep disorders, must be considered. He has published over 350 articles, essays, poetry, and commentaries in medical and nonmedical literature, as well as four medical textbooks and a book of short stories.
However, there is little evidence available for a period of 6 months and additional studies that directly address clinical outcomes in patients with chronic insomnia are needed. For many people, medication is a last resort after stimulus control, relaxation techniques, and other CBT-I methods were not effective in improving their sleep.