Chronic insomnia: a practical review
by
Rajput V, Bromley SM
Robert Wood Johnson Medical School,
Camden, New Jersey, USA.
Am Fam Physician 1999 Oct 1; 60(5):1431-8; discussion 1441-2

ABSTRACT

Insomnia has numerous, often concurrent etiologies, including medical conditions, medications, psychiatric disorders and poor sleep hygiene. In the elderly, insomnia is complex and often difficult to relieve because the physiologic parameters of sleep normally change with age. In most cases, however, a practical management approach is to first consider depression, medications, or both, as potential causes. Sleep apnea also should be considered in the differential assessment. Regardless of the cause of insomnia, most patients benefit from behavioral approaches that focus on good sleep habits. Exposure to bright light at appropriate times can help realign the circadian rhythm in patients whose sleep-wake cycle has shifted to undesirable times. Periodic limb movements during sleep are very common in the elderly and may merit treatment if the movements cause frequent arousals from sleep. When medication is deemed necessary for relief of insomnia, a low-dose sedating antidepressant or a nonbenzodiazepine anxiolytic may offer advantages over traditional sedative-hypnotics. Longterm use of long-acting benzodiazepines should, in particular, be avoided. Melatonin may be helpful when insomnia is related to shift work and jet lag; however, its use remains controversial.

SSRIs
Anxiety
Serotonin
Zopiclone
Trazodone
Sexsomnia
Nefazodone
Mirtazapine
Venlafazine
Sleeping-pill hype?
Sedative hypnotics
Drugs to treat insomnia
Insomnia and depression
Sleep maintenance insomnia
Hypersomnia and depression
Stress, depression and anxiety
Sleep dysfunction and psychiatric illness
The new sleeping pills: Lunesta, Sonata and Rozerem
Zolpidem (Ambien), Zaleplon (Sonata), Zopiclone (Imovane)

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