Guideline Recommendations for Chronic Insomnia Treatment (American Academy of Sleep Medicine, 2017)

First‑line Treatment Position

The American Academy of Sleep Medicine (2017) does not recommend zopiclone as a first‑line pharmacologic option for chronic insomnia in adults because it is absent from the guideline’s list of preferred hypnotic agents, which favor drugs with stronger evidence of efficacy and safety. 1, 2, 3

Eszopiclone (the S‑enantiomer of zopiclone) 2–3 mg at bedtime is suggested for patients with difficulty falling asleep and for maintaining sleep; the recommendation is classified as weak due to limited high‑quality evidence. 1, 2
Zolpidem 10 mg, zaleplon 10 mg, suvorexant, and selected benzodiazepines each receive a weak recommendation for chronic insomnia, reflecting modest efficacy data and concerns about safety or dependence. 1, 3

Taking eszopiclone (and by extension zopiclone) after a high‑fat meal can delay onset of action by approximately 1 hour; therefore the guideline advises administration on an empty stomach or at least 2 hours after a heavy meal. 2