https://canadianprimarycaretoday.com/ en-US Thu, 18 Sep 2025 15:54:09 +0000 OJS 3.3.0.13 http://blogs.law.harvard.edu/tech/rss 60 https://canadianprimarycaretoday.com/article/view/3-s01-Chow_et_al <p class="p1">Insomnia disorder is a complex condition in which patients experience difficulties with sleep initiation, sleep maintenance, or early morning awakening. Chronic insomnia is defined as dissatisfying sleep quality or quantity, occurring at least three times per week, that has persisted for at least three months.</p> <p class="p1">Insomnia is common, with a higher incidence in certain subpopulations, including older adults (≥65 years of age) and patients with psychiatric and physical comorbidities, such as depression, anxiety, dementia, restless leg syndrome, obstructive sleep apnea, chronic pain, and alcohol or substance use disorders. Individuals experiencing insomnia often have disrupted sleep architecture, with polysomnography showing reduced time spent in the rejuvenating slow wave and rapid eye movement (REM) sleep stages. As such, insomnia can seriously impair daytime functioning, cognition, and quality of life. Further, insomnia may result in a higher risk of various conditions, including cardiovascular disease, obesity, and diabetes, though the association between insomnia and these comorbidities is likely bi-directional. Unfortunately, for a variety of reasons, the diagnosis is often missed or trivialized in medical practice. Given the profound impact of chronic insomnia, a proactive diagnosis and successful treatment is essential.</p> <p class="p1">The primary non-pharmacologic treatment option available for insomnia is cognitive behavioural therapy for insomnia (CBT-I), which focuses on sleep hygiene techniques, sleep restriction, circadian rhythm therapy, and cognitive therapy. Although CBT-I is the first-line treatment for insomnia and should always be recommended, it may not always be available in a timely manner, it can be costly and not every patient can afford it, some patients choose to opt out, and may not be sufficient as a single therapy approach. Thus, in many cases, pharmacotherapy may be needed in addition to or instead of CBT-I to treat insomnia and improve daytime functioning and associated cardiovascular and metabolic risks. Of note, patients also often self-medicate with over-the-counter medications, including cannabis products.</p> <p class="p1">Currently, commonly prescribed medications for insomnia include benzodiazepine receptor agonists (BZDs; e.g., lorazepam, clonazepam) and Z-drugs (e.g., zolpidem, zopiclone, eszopiclone).¹⁰ In addition, despite their risks, antidepressants (e.g., trazodone, mirtazapine), and antipsychotics (e.g., quetiapine) have also been used to treat insomnia despite being off-label and promoting sleep indirectly.</p> Walter Chow, B.Sc. (Pharmacy), MD, Atul Khullar, MD, MSc, FRCPC, DABPN, Fiore Lalla, MDCM, FRCP, Serge Lessard, MD, FRCPC, Alan Lowe, BScPhm, MD, FRCPC, Diane McIntosh, MD Copyright (c) 2025 Canadian Primary Care Today https://creativecommons.org/licenses/by-nc-nd/4.0 https://canadianprimarycaretoday.com/article/view/3-s01-Chow_et_al Thu, 18 Sep 2025 00:00:00 +0000