Intended for healthcare professionals


Treating insomnia

BMJ 2004; 329 doi: (Published 18 November 2004) Cite this as: BMJ 2004;329:1198
  1. Anne M Holbrook, director (
  1. Division of Clinical Pharmacology, McMaster University, Hamilton, ON, Canada L8N 3Z5

    Use of drugs is rising despite evidence of harm and little meaningful benefit

    “By the way, doctor, I don't sleep at night. Can you give me something for that?” or “You can take away any of my other pills, but I have to have something for sleep!” are sentiments heard daily in any general medical environment. Patients with persistent complaints of insomnia—often elderly, frail, with multiple morbidities, multiple medications, already on or previously on a hypnotic medication—become problematic. Once past invoking sleep hygiene guidelines; looking for primary causes of insomnia; discussing medication risks such as falls, impaired cognition, driving crashes, and dependence; or discontinuing sedatives (and grumbling to the nurses for promoting them and to the house staff and referring doctors for prescribing them), what is the doctor to do? Why is this one of the least satisfying symptoms to treat and to educate medical professionals about?

    Perhaps because the definition of “normal sleep” remains elusive, as do the determinants of normal sleep, the correlation of psychopathology (which many doctors have neither time nor training to …

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