Pharmacologic treatment of insomnia: a new clinical practice guideline

The AASM recommends that the new pharmacologic guidelines be used in conjunction with other AASM guidelines for insomnia.
The AASM recommends that the new pharmacologic guidelines be used in conjunction with other AASM guidelines for insomnia.

The American Academy of Sleep Medicine (AASM) has released a new clinical practice guideline for the pharmacologic treatment of insomnia in adults.

The recommendations, which were published in the Journal of Clinical Sleep Medicine, include suggestions for FDA-approved drugs for insomnia, as well as for drugs that are frequently used to treat patients with insomnia but are not FDA-approved for this condition.

 

The AASM developed the following recommendations for clinicians:

Clinicians should use suvorexant as a treatment for sleep maintenance insomnia (vs no treatment) in adults.
Clinicians should use eszopiclone as a treatment for sleep onset and sleep maintenance insomnia (vs no treatment) in adults.
Clinicians should use zaleplon as a treatment for sleep onset insomnia (vs no treatment) in adults.
Clinicians should use zolpidem as a treatment for sleep onset and sleep maintenance insomnia (vs no treatment) in adults.
Clinicians should use triazolam as a treatment for sleep onset insomnia (vs no treatment) in adults.
Clinicians should use temazepam as a treatment for sleep onset and sleep maintenance insomnia (vs no treatment) in adults.
Clinicians should use ramelteon as a treatment for sleep onset insomnia (vs no treatment) in adults.
Clinicians should use doxepin as a treatment for sleep maintenance insomnia (vs no treatment) in adults.
Clinicians should not use trazodone as a treatment for sleep onset or sleep maintenance insomnia (vs no treatment) in adults.
Clinicians should not use tiagabine as a treatment for sleep onset or sleep maintenance insomnia (vs no treatment) in adults.
Clinicians should not use diphenhydramine as a treatment for sleep onset and sleep maintenance insomnia (vs no treatment) in adults.
Clinicians should not use melatonin as a treatment for sleep onset or sleep maintenance insomnia (vs no treatment) in adults.
Clinicians should not use tryptophan as a treatment for sleep onset or sleep maintenance insomnia (vs no treatment) in adults.
Clinicians should not use valerian as a treatment for sleep onset or sleep maintenance insomnia (vs no treatment) in adults.

“This analysis is, to the best of our knowledge, the most comprehensive assessment of efficacy of individual sleep-promoting agents published to date,” stated the guideline authors. “It relies heavily on rigorous evaluation of the quality of evidence for efficacy, based on GRADE, as well as determination of potential adverse effects, to the extent possible. It is intended to serve as a useful guide for clinicians in prescribing medications for the treatment of chronic insomnia.

“This analysis, however, also makes it abundantly clear that the availability and quality of the data which serve as the foundation for such recommendations are sorely limited,” the authors continued. “The result is that many commonly used drugs, including some which carry FDA approval for treatment of insomnia, are not recommended. Further data are required to formulate any reasonable conclusion regarding their efficacy or lack thereof. As a result, clinicians must continue to exercise sound clinical judgment, based not only on these recommendations, but also on clinical experience, prior patient response, patient preferences, and potential adverse effects.”

Reference

  1.  Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. 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;13(2):307–349.
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