When patients ask for hypnotics (sleeping pills), what should physicians advise? This review considers cognitive-behavioral therapy and hypnotics as alternative treatments. The effectiveness of cognitive-behavioral therapy for insomnia has been demonstrated. No appreciable risks have been reported. The risks of hypnotics include impairments of cognition and function, depression, cancer, and early mortality, but the newest hypnotics have surprisingly little objective benefit. The physician can help patients best by persuading them of the benefits of cognitive-behavioral approaches.
Introduction
Cognitive Behavior Therapy
Hypnotics Risk Versus Benefit
Mortality Risks of Hypnotics
Infection Risk of Hypnotics
Depression Risk of Hypnotics
Comments on Eszopiclone
Comments on Ramelteon
Comments on Zaleplon
Conclusions
Acknowledgment
References