Journal des troubles du sommeil et de la thérapie
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Chronic Insomnia, Pharmacotherapy and the Cognitive Behavioral Approaches

Mohammad Torabi Nami

Insomnia is a common complaint of patients presenting to primary care physician and sleep medicine experts. Approximately 10-20% of the general population worldwide has reported symptoms of chronic insomnia of which 25% have primary insomnia. Insomnia is more prevalent among females and the elderly subjects (over 65 years). Pharmacotherapy for insomnia is mainly focused on hypnotics such as benzodiazepine receptor agonists (BzRAs), antihistamine drugs, tricyclic antidepressants like doxepin, and a melatonin receptor agonist (ramelteon). However, these very often used medications are shown to have potential untoward effects outweighing their benefits in many instances. Once the underlying disorder affecting sleep is appropriately addressed, cognitive behavioral therapy, singly or combined with drug therapy, is demonstrated to be amongst the most efficacious treatment strategies in some cases with refractory insomnia.