Insomnia is generally defined as "sleeplessness" subdivided into: difficult to fall asleep (sleep initiation), waken at night and hard to fall back to sleep (sleep maintenance), sleep dissatisfaction despite adequate sleep opportunity associated with daytime drowsiness.
Insomnia can lead to next day sleepiness, confusion, lack of energy, loss of work productivity and motor vehicle accidents. Long-term insomnia may cause anxiety, depression and even suicidal thoughts in patients.
Primary Insomnia: insomnia not related to other causes. Secondary insomnia is associated with underlying causes such as anxiety, pain, psychological problem and medications. Therefore it is very important to access the underlying causes to make the rational treatment decision.
Management insomnia is usually treating the underlying cause. If the patient can't sleep due to pain, pain management would be the first choice. In addition, good sleep hygiene is recommended. If pharmacological treatment is needed, the use of drugs like Zaphlon (Sonata) a short-acting drug with fast onset, is a good recommendation, especially for those who have difficulty falling asleep. It can also be repeated for those who can't stay asleep since it affects may dissipate in 3 or 4 hours. Zolpidem (Ambien) is also a commonly recommended medication for patients who has trouble staying asleep and has a relatively fast onset of action (approximately 30 min).
Generally, OTC treatment of insomnia is not recommended.
For Journal of Clinical Sleep Medicine for Chronic insomnia click here.