Insomnia is a condition that affects nearly everyone at some point in life. Up to 40% of American adults have intermittent insomnia, and 10% to 15% have a chronic sleep problem. The main presentation of insomnia is difficulty with either falling asleep or maintaining sleep throughout the night.
Complaints of insomnia tend to increase with age. Elderly people report trouble falling asleep, sleeping less at night, waking more often during the night, waking up earlier than they would like, and feeling tired during the day. Younger adults tend to complain more of difficulty falling asleep.
Insomnia can lead to myriad problems, including next day-drowsiness, decreased performance at work or school, attention and memory problems, depression, and even car accidents. The proper diagnosis and treatment of insomnia are necessary to improve patients’ quality of life; however, insomnia is usually the result of another medical or psychiatric condition. The clinician should rule out all possible causes of insomnia and should address the underlying conditions rather than simply treat the patient with a sedative-hypnotic. Nonpharmacological options, such as sleep-behavior modifications, can also be effective.
However, sedative-hypnotic agents can play an important role in the treatment of insomnia. These medications reduce the time it take a person to fall asleep, called the “latency to persistent sleep” (LPS), as well as increase the total sleep time. Until now, sedative-hypnotics were indicated only for the short term, which made them ideal for use while addressing the cause of the patient’s insomnia. Eszopiclone (Lunesta™, Sepra-cor) is the first sedative-hypnotic drug approved by the Food and Drug Administration (FDA) for the long-term treatment of insomnia. In clinical trials of up to 12 months, no decrease in effectiveness has been observed.