Expert Perspectives on Chronic Insomnia Management

When treating chronic insomnia, health care providers, including neurologists and general physicians, are advised not to immediately resort to prescribing medication. Instead, they should invest time in obtaining a comprehensive sleep history or sleep diary from patients. Many insomnia cases stem from poor sleep habits, such as spending excessive time in bed or having misconceptions about the natural sleep process. In such instances, simply realigning a patient's bedtime with their natural melatonin production can often resolve the issue without the need for medication.

If medication is necessary, it is crucial for clinicians to be aware of the various available classes of treatments, especially newer ones that have more favorable adverse effect profiles. Older medications, like benzodiazepines, carry risks such as dependency and cognitive dysfunction, and patients who have been on these drugs for years may not have been offered newer, safer alternatives. Understanding and utilizing these newer agents can help avoid unnecessary adverse effects while still providing effective treatment for insomnia.

Looking to the future, the role of dual orexin receptor antagonists (DORAs) is expected to become more prominent in the treatment of chronic insomnia. These medications offer similar efficacy to older sleep aids but with a much more favorable safety profile. They are less likely to cause issues such as cognitive decline or an increased risk of falls, which is particularly important in older patients. As the medical community recognizes the importance of balancing efficacy with safety, it is hoped that DORAs will be used more frequently as a first-line treatment option, supported by a better understanding from payers regarding their value.