Pharmacologic and nonpharmacologic treatments of insomnia

Insomnia is present in high numbers of patients. As older women who have medical problems have the highest rates of chronic insomnia, physicians must have a high index of suspicion and explore various causes. Treatment should focus on setting specific goals, with strategies combining lifestyle changes, behavioral interventions, and appropriate medications. Over-the-counter agents, sedating antidepressants, and benzodiazepine agonists are used; close monitoring is needed to prevent falls, accidents, and cognitive impairment from these agents. Hypnotic agents are efficacious, but long-term studies have not been available until the recent release of eszopiclone in the United States. Recent work encourages using cognitive-behavioral therapy.