
Contents
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Introduction Introduction
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Neurotransmitters in insomnia treatment Neurotransmitters in insomnia treatment
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Mode of action of licensed hypnotics Mode of action of licensed hypnotics
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Drugs that act on GABAA receptors Drugs that act on GABAA receptors
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Melatonin and melatonin agonists Melatonin and melatonin agonists
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Antihistamines Antihistamines
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Antidepressants Antidepressants
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Practical considerations when prescribing for insomnia Practical considerations when prescribing for insomnia
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When should you prescribe hypnotics? When should you prescribe hypnotics?
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When do you want the drug to work? When do you want the drug to work?
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How important is it to avoid morning hangover? How important is it to avoid morning hangover?
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Comorbid conditions Comorbid conditions
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Addiction Addiction
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Stopping hypnotics Stopping hypnotics
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References References
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6 Medical management of insomnia
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Published:February 2022
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Abstract
Insomnia is defined as difficulty initiating or maintaining sleep with associated impaired daytime functioning. It is the most common sleep and mental health disorder, present in ~10-30% of the adult population. The consequences of insomnia are significant, including: increased risk of health problems, work absenteeism, reduced productivity, increased health-care utilization and nonmotor-vehicle accidents. Psychological and behavioural therapies are recommended as the first line and gold standard treatments for insomnia. This chapter summarizes common non-pharmacologic treatment approaches, as well as the evidence base supporting their use. Emerging treatment options are also outlined. Consideration is given to special populations, including: older adults, children and teens, co-morbid insomnia, and individuals taking hypnotics. Practical aspects of administering therapy are also summarized, including: contraindications, risks, managing resistance and relapse-prevention.
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