Cognitive-behavioral therapy for sleep disorders, sometimes referred to as CBT-I, is an effective treatment for chronic sleep disorders and is usually recommended as a first line of treatment. Because prolonged use causes tolerance and dependence, benzodiazepines are best for treating sleep disorders in the short term. The purpose of this perspective is to delineate the limitations in the implementation of cognitive behavioral therapy (CBT) and to review the pharmacological treatments that target the various phenotypes of sleep disorders. Selective, non-benzodiazepine-sedative “Z-drug hypnotics,” the melatonin receptor agonist Ramelteon, and low-dose doxepin are the drugs of choice for treating primary and comorbid insomnia.
Overall, the evidence base for CBT-I is stronger than for drugs.
What is the first drug treatment for sleep disorders?
Zolpidem, an imidazopyridine class tranquilizer, has a rapid onset of action and a short duration of action. Be sure to consult your doctor or other licensed physician before taking any medication for sleep disorders. Although they are not approved by the FDA to treat sleep disorders, atypical antipsychotics such as quetiapine, olanzapine, and risperidone are often prescribed for sleep disorders. Healthcare providers must carefully consider those at greatest risk of sleep disorders, including older people, women, shift workers, people with comorbid medical and psychiatric conditions, and people with less education.
Although there are no good studies that compare benzodiazepines directly with Z-hypnotics, indirect comparisons suggest similar effectiveness.