1/23/2024 0 Comments Long term symptoms of insomnia![]() ![]() This view was also noted by the European Guideline for the Diagnosis and Treatment of Insomnia, which was endorsed by the World Sleep Society. harms of the long-term use of pharmacologic therapies for chronic insomnia. The recommendation by the ACP Clinical Practice Guideline on the Management of Chronic Insomnia Disorder in Adults that medication use should be limited to 4–5 weeks derives from the assessment that the evidence is insufficient to adequately weigh the benefits vs. The use of BZDs, and in particular long-term use, is not recommended in older adults due to the increased risk for these adverse events. BZDs, for example, have been associated with the potential risk of falls and cognitive impairment, as well as the potential of abuse and dependence. Guidelines recommend a shared decision-making model when selecting pharmacologic agents for insomnia, with consideration of the types of patient-reported symptoms (difficulty falling asleep, staying asleep, early morning awakening), medical and psychiatric co-morbidities, concurrent pharmacotherapy, and symptom duration when weighing the risks and benefits of specific medication classes and duration of use. ![]() Data from multiple randomized controlled trials support the efficacy of several approved pharmacological treatments including several different drug classes, such as benzodiazepine (BZD) and non-benzodiazepine (non-BZD) GABA-A modulators, dual orexin receptor antagonists (DORAs), melatonin receptor agonists and histamine antagonists. While cognitive behavioral therapy for insomnia (CBT-I) is recommended as first-line therapy, pharmacologic therapy is commonly used in the management strategy for treating insomnia. Insomnia is also bi-directionally linked to mood disorders, in that insomnia is a risk factor for depression and depression has been shown to predict the persistence of insomnia. Women experience higher rates of insomnia compared to men and the prevalence of insomnia increases in older populations. By the time most patients with insomnia present for treatment, sleep has been disrupted for a duration of at least 3 months and thus meet the criteria for chronic insomnia disorder. The clinical diagnostic criteria defining insomnia disorder include not only symptoms of difficulty falling asleep, staying asleep and/or earlier awakening than desired for at least three times per week, but also the consequent daytime functional impairments. ![]() Insomnia is among the most common medical conditions worldwide, affecting 15–30% of the general population. Thus, an evaluation of evidence supporting the long-term safety and efficacy of newer non-benzodiazepine hypnotics is timely and should be considered in practice recommendations for the duration of pharmacologic treatment of chronic insomnia. For eszopiclone, doxepin, ramelteon and the newer class of dual orexin receptor antagonists, the FDA label does not specify that their use should be of a limited duration. After discussion of the literature, the panel unanimously agreed that some classes of insomnia medications, such as non-benzodiazepines hypnotics, have been shown to be effective and safe for long-term use in the appropriate clinical setting. Survey respondents revealed a wide range of opinions regarding the appropriateness of using the US Food and Drug Administration (FDA)-approved medications for the treatment of insomnia lasting more than 3 weeks. The panelists’ assessment was also compared to findings from a national survey of practicing physicians, psychiatrists, and sleep specialists. A panel of sleep experts conducted a clinical appraisal regarding the use of insomnia medications, as it relates to the evidence supporting the focus statement, “No insomnia medication should be used on a daily basis for durations longer than 3 weeks at a time”. While evidence supports the benefits of medications for the treatment of chronic insomnia, there is ongoing debate regarding their appropriate duration of use. ![]()
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