By vgreene, 19 March, 2018 If behavioral/pharmacologic tx fails or if reasonable suspicion of sleep breathing/movement disorder: Order polysomnography2,5
By vgreene, 19 March, 2018 Light therapy/exercise may be useful as adjunct tx, but more studies needed2
By vgreene, 19 March, 2018 Harms of hypnotic agents 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/ inf
By vgreene, 19 March, 2018 Reduce doses of BZD and non-BZD 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, 19 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
By vgreene, 19 March, 2018 Consider pharmacological tx only for short-term use1,2—ideally no longer than 4-5wk
