A review on holistic and pharmacological management of insomnia

Abstract

Insomnia is a common sleep disorder that has negative impacts on quality of life. It significantly reduces productivity and cognitive function, and in worst cases, causes morbidity and mortality. The various types of insomnia are described according to the duration of the perceived symptoms. It is characterised by both nocturnal and daytime symptoms, with daytime symptoms often the reason for treatment. The disorder may be precipitated by several cognitive behavioural factors.

Although pharmacotherapy is a common option of treatment, clinical guidelines and literature recommend cognitive behavioural therapy as the gold standard and the first-line treatment option. Pharmacotherapeutic agents range from over-the-counter agents, e.g. antihistamines, to scheduled drugs like benzodiazepine receptor agonists. The dual orexin receptor antagonists represent the newest class of drugs indicated for the treatment of insomnia. First registered in 2014, the Food and Drug Authority regulatory body has since approved three agents in this class. Furthermore, the off-label use of medicines with sedating effects is very common in the treatment of insomnia. The popular classes of medicine include sedative antidepressants, atypical antipsychotics, and gabapentinoids. Complementary and alternative therapies, which include dietary and herbal supplements, may be considered an alternative option.

This review discusses the various available therapy options for the treatment of insomnia. The mechanisms of action and adverse effect profiles were elucidated to provide clinical guidance on considerations for the selection of sedative hypnotics to treat insomnia.