FDA-approved Nonbenzodiazepine Receptor Agonists for the Management of Insomnia

Jon P. Wietholter, PharmD, BCPS; Renier Coetzee, BPharm, MPharm, PharmD


US Pharmacist. 2017;42(1):29-32. 

In This Article

Nonpharmacologic Treatment

The management of insomnia is dependent on a number of variables, including classification of insomnia, comorbid conditions, and patient-specific factors. Appropriate treatment of coexisting medical, psychiatric, or other sleep disorders is essential for the proper management of insomnia.[2] It is also recommended that treatment of insomnia include at least one behavioral intervention.[10] Potential components of nonpharmacologic therapy for insomnia include proper sleep hygiene, stimulus control, sleep restriction, relaxation training, and/or cognitivebehavioral therapy (CBT).[11]

One hallmark of insomnia treatment is CBT. This approach uses a combination of cognitive therapy, stimulus control, and sleep restriction therapy with or without relaxation therapy. Various trials have shown that CBT has a significant effect on the short- and long-term treatment of chronic insomnia, especially in patients with a psychiatric or medical comorbidity.[6] In two separate trials, cognitive behavioral therapy was shown to sustain patients' sleep improvements at 12 and 24 months when compared to pharmacotherapy alone.[12,13]

During a CBT session, patients are educated about good sleep practices, how to complete a sleep diary, and dysfunctional beliefs and misconceptions about insomnia. Patients are also taught principles of stimulus control and sleep restriction. Stimulus control teaches patients to eliminate distractions and associate the bedroom only with sleep and sex. It also involves going to bed only when tired and leaving the room if not asleep within 15 to 20 minutes. Patients are asked to estimate their total time asleep by using diaries, and to restrict their time in bed to the average necessary sleep time. Time in bed must not be <5 hours, and morning wake time should be consistent throughout treatment.[10,11]