Insomnia

Chronic insomnia may persist for months or years. The safety of long-term hypnotic use is unclear. Some guidelines recommend limiting treatment with hypnotics to the short term (4-5 weeks).[124]Qaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016 Jul 19;165(2):125-33. https://www.acpjournals.org/doi/10.7326/M15-2175 http://www.ncbi.nlm.nih.gov/pubmed/27136449?tool=bestpractice.com However, other guidelines do not suggest this limitation.[104]Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017 Feb 15;13(2):307-49. https://jcsm.aasm.org/doi/10.5664/jcsm.6470 http://www.ncbi.nlm.nih.gov/pubmed/27998379?tool=bestpractice.com ​ The US Food and Drug Administration (FDA) has approved all hypnotics since 2004 without limitation on the duration of treatment. Hypnotic taper should be offered to all patients; however, this should only occur (with the exception of the occurrence of an acute treatment-emergent safety issue) involving a shared decision-making approach that incorporates patient preference and values. Other acceptable options include switching to another hypnotic.

Cognitive behavioural therapy for insomnia (CBT-I) has the potential to resolve the condition but requires effort and commitment on the part of the patient and practitioner.