I posted this on the Medscape message boards today:
I see a lot of pts who have failed the standard hypnotics (Rozerem, Ambien, Ambien CR, Lunesta, Sonata). It's important to screen for secondary causes, including restless legs. If they haven't taken Restoril yet, that's sometimes effective. I have found chloral hydrate effective for short term use (no more than 1 month), for breaking the cycle of insomnia. I have one patient on Xyrem for insomnia (and several who take it for narcolepsy). Before prescribing xyrem, it's important to rule out obstructive sleep apnea. I'll occasionally use Seroquel for insomnia, but only if there is comorbid psychiatric illness. I'll also sometimes use neurontin, but usually only if there are also neuropathic/RLS symptoms present.
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4 comments:
CBTI is extremely useful in patients with chronic insomnia. I've been able to help most patients who are open to this type of treatment. I agree that other sleep, psychiatric and medical comorbidities should be treated or ruled out for optimal results.
Why does insomnia happen? The answer is not always clear, sometimes it is caused by stress and other times there might be no apparent reason. There are ways you can improve both the quality and length of your sleep and break free of your patterns of poor sleep habits. You need not fear the night. http://www.besthealthmed.com/sleep_problems.html
I have had severe, chronic insomnia resistant to Ambien (no response whatsoever), Lunesta (again no response), Sonata (also no response), and even, after a while, chloral hydrate. I suffer from severe, chronic pain, which is being treated satisfactorily with several modalities, and have been battling this especially lately. I, and my doctors are extroridinarily frustrated, and the chornic sleepiness has my family and friends thinking I have relapsed on drugs and alcohol. I assure you I have not. I feel like I am going nuts. I have also tried ever stress relieving modality, naturopathic and homeopathic remedy, ad nauseum. This has been going on for fifteen years. If anyone has any ideas, I am open to them. I have had many a medication holiday also.
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