Treatment of insomnia

The prevalence of insomnia is high in the population of western industrial countries (up to 35 %). Sleep disturbance may consequently lead to an impairment of cognitive functions, mood disturbance and metabolic alterations. Therefore, the confirmation of insomnia and its diagnostic characterization is of great importance. Treatment of insomnia is based on its aetiology and intensity. For secondary insomnia treatment of the basic disorder is mandatory. Before the initiation of a symptomatic pharmacological treatment the application of non-pharmacological interventions should be considered. Efficacious pharmacological interventions are non-benzodiazepine hypnotics for a limited time span. If a longer treatment of insomnia is necessary, hypnotic antidepressants and hypnotic neuroleptics (without anti-cholinergic action) can be applied taking the specific side effects into account. Classical benzodiazepines and substances with anti-cholinergic properties should be avoided in particular in long-term treatment and in elderly subjects due to its side effect profile.