What is the right drug for insomnia disorder?

Microgen images/Science Photo Library The result that benzodiazepines were the most effective treatments for the short term was not surprising; unfortunately, no data were available for the long-term treatment, but we should keep in mind the well recognised potential for misuse and dependence.3 Moreover, this class of psychotropic drugs was shown to cause more side-effects than placebo at the study endpoint.2 Except for zaleplon, the so-called Z-drugs—namely, zopiclone, eszopiclone, and zolpidem—were shown to be effective for insomnia disorder and, although initially thought a safe alternative to benzodiazepines, were also not free from safety concerns2 and seem to share a similar risk of misuse and dependence.3 Dual orexin receptor antagonists constitute a newer class of sleep drugs that includes daridorexant, lemborexant, seltorexant, and suvorexant. A recently published comprehensive overview of systematic reviews compared the effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia disorder.6 This study confirmed that CBT is a first-line treatment because of its consistent and robust evidence of effectiveness across many outcomes, as well as the fact that it is expected to have few or no major side-effects. [...]pharmacological interventions for insomnia could be considered as second-line treatments.6 De Crescenzo and colleagues,2 have succeeded in depicting all available evidence in sleep medications for insomnia disorder; they concluded that eszopiclone and lemborexant had the best profile, although might cause substantial adverse events. In future research, other sources of evidence, especially about the side-effect profiles of these medications, should be considered. [...]trials with a duration longer than 3 months that directly compare active drug treatments and non-pharmacological interventions are warranted to provide clear answers to clinicians and patients.