By vgreene, 20 March, 2018 If behavioral/pharmacologic tx fails or if reasonable suspicion of sleep breathing/movement disorder: Order polysomnography2,5
By vgreene, 20 March, 2018 Light therapy/exercise may be useful as adjunct tx, but more studies needed2
By vgreene, 20 March, 2018 Harms include:1 cognitive/behavioral changes such as daytime impairment, “sleep driving,” worsening depression, suicidal thoughts/actions (primarily in depressed pts)1 and/or if taking both sedatives and hypnotics;3 may be assoc w/ infrequent, but serious
By vgreene, 20 March, 2018 Reduce doses of BZD and nonBZD hypnotics in women, older, and/or debilitated adults;1 ESRS says to strongly consider reducing to intermittent dosing in pts taking daily BZDs, BZRAs, or sedating antidepressants2
By vgreene, 20 March, 2018 Monitor tx response in older adults closely, as they may be more sensitive to meds and their adverse effects1
By vgreene, 20 March, 2018 If insomnia doesn’t remit w/in 7-10 days of tx: Evaluate further. If shared decision made to continue meds ≥4-5wk: Reassess need for med continuation at periodic intervals1
