Treatment Options for Sleep Onset and Maintenance Insomnia

First-Line Treatment

• The American Academy of Sleep Medicine recommends cognitive behavioral therapy for insomnia (CBT-I) as the preferred first-line approach for patients with both sleep onset and maintenance insomnia 1, 2

Pharmacological Options for Both Sleep Onset and Maintenance Insomnia

• The American Academy of Sleep Medicine recommends eszopiclone, zolpidem, and temazepam as pharmacological treatment options for both sleep onset and maintenance insomnia 1, 2, 3

Medications for Specific Insomnia Types

• The American Academy of Sleep Medicine recommends zaleplon, triazolam, and ramelteon for sleep onset insomnia 1, 2, 3
• The American Academy of Sleep Medicine recommends suvorexant and doxepin for sleep maintenance insomnia 1, 2, 3

Medications Not Recommended

• The American Academy of Sleep Medicine does not recommend trazodone, tiagabine, diphenhydramine, melatonin, tryptophan, or valerian for either sleep onset or maintenance insomnia 1, 2

Clinical Considerations and Caveats

• The American Academy of Sleep Medicine notes that all pharmacological recommendations are rated as "WEAK" according to GRADE methodology, indicating that benefits outweigh harms but many patients might choose not to use these treatments 3
• The American Academy of Sleep Medicine suggests that CBT-I should be considered before or alongside pharmacotherapy due to its sustained benefits without tolerance or adverse effects 2