Insomnia is a common clinical condition characterized by difficulty initiating or maintaining sleep, accompanied by symptoms such as irritability or fatigue during wakefulness. The prevalence of insomnia disorder is approximately 10% to 20%, with approximately 50% having a chronic course. (Buysee, 2013)
First line therapy for insomnia should always include behavioral modifications such as sleep hygiene and insomnia-oriented cognitive behavioral therapy. In patients deemed to need pharmacotherapy, first line medications include nonbenzodiazepine hypnotics and antidepressants depending on the patients’ needs and comorbidities. (Bragg et al, 2019).
CBT is an effective treatment for adults with chronic insomnia. (Trauer et al, 2015).
Possible medications include suvorexant (orexin receptor antagonists), low-dose doxepin (TCA), Z-drugs or non-benzos (eszopiclone, zolpidem, zaleplon), benzodiazepines (triazolam, temazepam), and ramelteon (melatonin receptor agonists).
*Note: There has been published that a relationship between insomnia and bruxism might exist: “Insomnia is likely a condition associated with SB, especially in middle-age females, while sleep apnea seems age and gender dependent”. (Maluly et al, 2020).
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Maluly M, Dal Fabbro C, Andersen ML, Herrero Babiloni A, Lavigne GJ, Tufik S. Sleep bruxism and its associations with insomnia and OSA in the general population of Sao Paulo. Sleep Med. 2020 Nov;75:141-148. doi: 10.1016/j.sleep.2020.06.016. Epub 2020 Jun 20. PMID: 32858352.