Guideline Recommendations for Insomnia Pharmacotherapy in Intellectual Disability

American Academy of Sleep Medicine (AASM) Recommendations for General Adult Insomnia

The American Academy of Sleep Medicine recommends against using melatonin for insomnia in neurotypical adults, citing insufficient efficacy evidence. 1, 2
The American Academy of Sleep Medicine advises against the use of trazodone, diphenhydramine, tiagabine, and valerian for general adult insomnia. 1, 2
The American Academy of Sleep Medicine recommends suvorexant for sleep‑maintenance insomnia in the general adult population, typically at doses of 10–20 mg. 4, 1, 2

Inappropriate prescribing of conventional hypnotics in individuals with intellectual disability is associated with polypharmacy, significant side‑effects, and poorer long‑term outcomes. 3
Benzodiazepines and Z‑drugs (e.g., zolpidem, eszopiclone, zaleplon) show higher rates of paradoxical responses, treatment resistance, and adverse effects in the intellectual disability population. 3
Behavioral (non‑pharmacologic) interventions demonstrate efficacy comparable to pharmacologic treatments for challenging behaviors linked to sleep problems in individuals with intellectual disability. 3