Fast Five Quiz: COVID-Related Conditions

Michael Stuart Bronze, MD; Vecihi Batuman, MD; Arlen D. Meyers, MD, MBA; Stephen Soreff, MD; Helmi L Lutsep, MD

Disclosures

March 16, 2021

CBT can be used to ameliorate factors that perpetuate or exacerbate chronic insomnia, such as poor sleep habits, hyperarousal, irregular sleep schedules, inadequate sleep hygiene, and misconceptions about sleep, and clinical depression. CBT is most effective for primary insomnia, but it is also effective for comorbid insomnia as adjunctive therapy. The American Academy of Sleep Medicine evidence-based practice parameter found that CBT (all components), as well as individual components of stimulus control, paradoxical intention, relaxation training, and biofeedback, were effective.

According to guidelines, such as those from the American College of Physicians, CBT should be the initial treatment option in patients with chronic insomnia. CBT has also demonstrated success in weaning patients from hypnotics compared with tapering of medications alone.

Components of CBT include:

  • Sleep hygiene education

  • Cognitive therapy

  • Relaxation therapy

  • Stimulus-control therapy

  • Sleep-restriction therapy

Antihistamines are the major ingredients of over-the-counter sleep aids and are ingredients in cold and sinus formulas sold as bedtime use medications. Nevertheless, common antihistamines (ie, first-generation H1-receptor antagonists such as diphenhydramine, hydroxyzine, and doxylamine) are not indicated for the treatment of insomnia.

Ramelteon (Rozerem), a melatonin receptor agonist, is approved by the US Food and Drug Administration for use in persons with insomnia. It has been shown to have no potential for abuse and, as such, is the first nonscheduled prescription drug available in the United States for the treatment of insomnia. This medication is suited for patients with sleep-onset insomnia, particularly for elderly patients with gait disorders who have an increased risk for falls and for patients with a history of substance abuse. The typical starting dose is 8 mg before bedtime. Ramelteon is not effective for sleep-maintenance insomnia.

Read more about the treatment of insomnia.

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