Selecting a hypnotic, anyone?

Insomnias have various etiologies and recognition of these should enable initiation of an appropriate treatment. In all cases, behavioral and nutritional measures constitute an important component of treatment. However, when insomnia is poorly tolerated, with physical and/or psychological repercussions, recourse to a hypnotic is justified.

The choice of hypnotic should be a matter of careful thought and should take into account, besides the efficacy of the product on the various types of insomnia, its likely side-effects, differing in nature and importance according to the pharmacological class in particular. the residual effects of the hypnotic may have am adverse impact on day time vigilance and psychomotor performance or be associated with impairment of cognitive functions, thereby minimizing the benefits of the sleep recovered.

The emergence of rebound phenomena on treatment discontinuation i.e. an aggravation of insomnia such that this becomes more severe than the original disorder prompting prescription of the hypnotic, may take it difficult to stop the treatment and consequently lead to an undesirable prolongation of hypnotic use.

This phenomenon is more frequently observed with short-acting benzodiazepines. The likelihood of development of tolerance, necessitating a progressive increase in dose to maintain the same effect or of dependence must also be assessed.