A 2023 Update on Managing Insomnia in Primary Care

Abstract

Objective: To evaluate the status of management of insomnia disorder, describe gaps in current recognition and treatment, identify current guidance for optimal management, and develop up-to-date educational recommendations for primary care providers. Participants: Four insomnia experts representing primary care, psychiatry, and clinical research were selected based on clinical expertise, educational qualifications, and research experience. A patient with insomnia was also included. Consensus Process: The Insomnia Working Group met in March 2022 to review data on available therapies (including medications approved since publication of current guidelines) and share current best practices for evidence-based multimodal treatment of insomnia disorder. Conclusions: Insomnia is highly prevalent but underdiagnosed

Wake Up America: National Survey of Patients’ and Physicians’ Views and Attitudes on Insomnia Care

“…A 2023 update by the Insomnia Working Group highlighted that challenges exist in treating insomnia with commonly used off-label drugs, including trazodone [ 30 ]. Per the Insomnia Working Group, trazodone is the most frequently prescribed medication for insomnia in the primary care setting in the United States [ 30 ].…”

“…A 2023 update by the Insomnia Working Group highlighted that challenges exist in treating insomnia with commonly used off-label drugs, including trazodone [ 30 ]. Per the Insomnia Working Group, trazodone is the most frequently prescribed medication for insomnia in the primary care setting in the United States [ 30 ]. The WUA surveys are consistent with this report, showing that this antidepressant was the top prescribed medication for insomnia among respondents; this is also consistent with other studies citing its use in patients with insomnia (18–55%) [ 25 , 26 ].…”

“…Nonmedication treatment options other than CBT-I are not included in the AASM guidelines [ 14 , 15 ]. The increasing availability of nonprescription CBD products may lead to more patients using these for trouble sleeping [ 30 ]. More than one-third of PWTS in this survey reported using CBD.…”

“…In another survey of the general US population with a similar demographic background as WUA, approximately 26% of respondents used CBD products [ 33 ]. Evidence supports the potential use of medical marijuana and related products for conditions like pain or anxiety, which are commonly comorbid with insomnia [ 30 ].…”

Failure of the dual orexin receptor antagonist suvorexant to engender drug discrimination in rats

“…DORAs reduce wakefulness in a very specific manner. They lack the more widespread brain-inhibitory and sedative effects of conventional sleep aids based on positive gamma-aminobutyric acid type A (GABA-A) receptor modulation such as zolpidem and are associated with fewer side effects (Rosenberg et al, 2023). Our results add to these differences, demonstrating that the discriminative stimulus properties of zolpidem are perceived more intensely by rats than those of suvorexant, despite both drugs promoting sleep.…”