Managing insomnia: an overview of insomnia and pharmacologic treatment strategies in use and on the horizon

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Abstract

This review explores basic sleep physiology, the mechanism of action for each class of hypnotic agents, their clinical application based on pharmacodynamic and pharmacokinetic factors, and potential pharmacologic sleep-inducing mechanisms of future hypnotics. The paper challenges the reader to understand the neuroscientific basis of insomnia and use this knowledge to guide prescription of hypnotic agents. Currently indicated hypnotic agents are discussed with regard to their mechanism of drug action and clinical application. A broader discussion is developed throughout this paper regarding other non-indicated agents that may improve sleep and describing newer pharmacological treatments that may become available in the future for use in sleep disorders and their comorbid conditions.

Keywords: hypnotic agents, insomnia, sleep, sedatives

Citation: Schwartz TL, Goradia V. Managing insomnia: an overview of insomnia and pharmacologic treatment strategies in use and on the horizon. Drugs in Context 2013;212257. doi: 10.7573/dic.212257

Provenance: Invited; externally peer reviewed

DatesSubmitted: 4 September 2012
; Accepted, subject to peer review: 6 September 2012
; Revised manuscript submitted: 30 August 2013; 
Published: 4 October 2013

Copyright: © 2013 Schwartz TL, Goradia V. This is an open-access article distributed under the terms of the Creative Commons Attribution License Deed CC BY NC ND 3.0 which allows anyone to copy, distribute and transmit the article provided it is properly attributed in the manner specified below. No other uses without permission.

Correct attribution: Copyright © 2013 Schwartz TL, Goradia V. http://dx.doi.org/10.7573/dic.212257. Published by Drugs in Context under Creative Commons Attribution License Deed CC BY NC ND 3.0.

Correspondence: Thomas L Schwartz, MD, SUNY Upstate Medical University, Psychiatry Department, 750 East Adams Street, Syracuse, NY 13210, USA

Email: schwartt@upstate.edu

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