Long-Term Pharmacotherapy in the Management of Chronic Insomnia
Abstract
Chronic insomnia is common among primary care patients and often necessitates long-term management. The available treatment options for the clinical care of such patients are limited. Medication management is the most common therapy for this condition; however, this practice was hindered until recently by clinical guidelines that discouraged the prescription of the medications approved by the Food and Drug Administration for longer than 4 weeks. Further, few research studies have been conducted on the longer-term medication management of insomnia that might allow clinicians to assess the expected risks and benefits of longer-term therapy. Recent research, however, indicates that longer-term treatment with some agents may be safe and effective. This article reviews these studies and discusses them in the context of the diagnostic steps to consider when deciding whether to initiate or continue pharmacotherapy for insomnia.
A.D.K. and M.A.F. received compensation from Sepracor Inc. for the services they provided in support of the development of this manuscript. (S.R. opted not to receive compensation.)
1 Andrew D. Krystal, MD, MS, is associate professor with tenure in the Department of Psychiatry at Duke University Medical Center. He directs the Sleep Research Laboratory and Insomnia Program. He is board certified in psychiatry, sleep medicine, and clinical neurophysiology and works primarily in the areas of sleep and mood disorders. He has research grant support from NIH, Sepracor, Pfizer, Merck, Somaxon, Neurocrine, GlaxoSmithKline, Sanofi-Aventis, Cephalon, and Respironics. He serves as a consultant for Sepracor, Somaxon, Neurocrine GlaxoSmithKline, Pfizer, Sanofi-Aventis, Cephalon, Respironics, Neurogen, Transoral, Takeda, Johnson & Johnson, Lilly, King, and Organon and is a speaker for Sepracor and Sanofi-Aventis.
2 Shari Rogers, MSN, CRNP, ACNP-BC, is a board-certified acute care nurse practitioner with the Sleep Medicine Center at the University of Pittsburgh Medical Center. She also serves as adjunct faculty for the Acute Care Nurse Practitioner Program at the University of Pittsburgh School of Nursing.
3 Margaret A. Fitzgerald, MS, APRN, BC, NP-C, FAANP, CSP, is the president of Fitzgerald Health Education Associates, Inc. in North Andover, Mass, and a board-certified family nurse practitioner and Certified Speaking Professional. She is a family practice provider at the Greater Lawrence (Mass) Family Health Center where she also serves as adjunct faculty to the Health Center's Family Practice Residency Program. She has relationships with Sepracor, GlaxoSmithKline, Janssen Ortho-McNeil, and Schwarz Pharma.
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