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) and/or if taking both sedatives and hypnotics;3 may be assoc w/ infre
By vgreene, 19 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, 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
By vgreene, 19 March, 2018 If comorbidities: Use clinical judgment to decide whether to treat insomnia or comorbid condition first, or both concurrently3
By vgreene, 19 March, 2018 Offer CBT I1 as 1st line tx for chronic insomnia1 2 in adults of any age 1 3multimodal CBT I administered by trained clinician mental health professional consists of the following 1
By vgreene, 19 March, 2018 Behavioral strategies (sleep restriction,1 sleep diaries,3 stimulus control1,3)
By vgreene, 19 March, 2018 Educational interventions (sleep hygiene); not alone, in absence of CBT-I, per VA4
