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Trazodone and gabapentin, two medications originally developed for different purposes, have emerged as potential allies in the battle against insomnia and other sleep-related issues. Trazodone, primarily known for its use in treating depression and anxiety , has gained popularity as a sleep aid due to its sedative properties. Insomnia may present with a variety of specific complaints and eti-ologies, making the evaluation and management of chronic insomnia demanding on a clinician’s time. The purpose of this clinical guideline is to provide clinicians with a practical framework for the assessment and disease management of chronic adult insomnia, using existing Insomnia is one of the most common symptoms for which adults seek medical advice. While pharmacotherapy should not be the sole treatment for insomnia, medication may be part of an integrated approach that includes behavioral strategies and treatment of relevant comorbidities. Most studies show that gabapentin improves slow wave sleep (“deep sleep”) and total sleep time. Two small studies showed that gabapentin may help people with primary insomnia and occasional sleep disturbance improve total sleep time and wakefulness in the morning. Insomnia affects 30% of the U.S. population, with 5% to 15% meeting criteria for chronic insomnia. It can negatively impact quality of life, decrease productivity, increase fatigue and drowsiness Available research suggests that gabapentin may be helpful for primary insomnia. But we need more studies before we can determine if the benefit outweighs the risk. A study of over 250 people with occasional insomnia found that taking 250 mg of gabapentin before bedtime increased the length of time people slept . Chronic insomnia is associated with increased risks of major depression, 5 hypertension, 6 Alzheimer’s disease, 7 and work disability. Gabapentin (7 hr) Some studies have found that gabapentin may increase slow-wave sleep, also known as deep sleep, which is crucial for physical restoration and cognitive function. Additionally, it may reduce sleep fragmentation, leading to fewer nighttime awakenings and improved sleep continuity. Gabapentin, a calcium channel/γ-aminobutyric acid–modulating medication, exhibits promise as another off-label pharmacotherapy for insomnia, especially effective for patients with underlying anxiety, chronic pain, or coexisting alcohol dependence. 8 – 10 Gabapentin has advantages as a hypnotic medication: few adverse drug interactions, a A randomized, double-blind, placebo-controlled, multicenter, 28-day, polysomnographic study of gabapentin in transient insomnia induced by sleep phase advance. J Clin Sleep Med. Common Problems: Gabapentin ED visits involving nonmedical use of gabapentin increased by 90% between 2008 and 2019 Concurrent gabapentinoid was present in up to 26% of opioid abusers ~ 24% of individuals had >3 instances in which they ingested more than 3,600 mg in a 12-month follow-up period Induces gabapentin’s psychoactive effects Preliminary evidence indicates that gabapentin can attenuate insomnia, bolster sleep quality, and increase total sleep duration. Moreover, gabapentin has been shown to increase slow-wave sleep (SWS), promote sleep maintenance, and decrease unwanted awakenings throughout the night. Introduction:The purpose of this guideline is to establish clinical practice recommendations for the pharmacologic treatment of chronic insomnia in adults, when such treatment is clinically indicated. Unlike previous meta-analyses, which focused on broad In contrast to patients presenting with an acute onset insomnia of short duration where the use of a FDA-approved hypnotic for several consecutive nights is usually sufficient for patients to overcome the stressful event, in chronic insomnia, it is recommended that patients receive appropriate treatment for co-existing medical and psychiatric Effective insomnia treatment requires a multidisciplinary team that is centred on the patient’s preference and personal goals. Key points. Bouts of insomnia occurring for <3 months can be treated pharmacologically, though ongoing monitoring is necessary. Insomnia disorder occurring for >3 months is best treated and managed using CBT-I. The optimal use of gabapentin for sleep involves careful consideration of timing, dosage, and integration with good sleep hygiene practices. Typically, taking gabapentin 1-2 hours before bedtime allows for its sleep-promoting effects to align with the desired sleep onset.
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