Insomnia: Differential diagnosis and current treatment approach

Abstract

Insomnia is a common complaint that chronically affects at least 14% of the population, leading to deficits in waking performance and quality of life. Insomnia can occur as a primary condition, but it can also be secondary to a wide spectrum of medical, psychiatric, and sleep disorders. The principal treatment strategies for insomnia include addressing comorbid conditions, cognitive and behavioral therapies, and the utilization of hypnotic medications when appropriate, ideally ones with limited potential for addiction or overdose, and low toxicity. It is remarkable that most drugs affecting the global state of sleep exert their effects through one primary neurotransmitter receptor system - the GABA receptor. When utilized as hypnotics, agents with general and indiscriminate effects on the GABA receptor can induce a combination of sedative, anxiolytic, amnestic, and even anesthetic effects, often with negative and detrimental consequences for the patient. However, recently developed hypnotics, exerting primary effects at the α1 subtype GABA-A receptor system, have been shown to have long-term efficacy as well as low toxicity, low addictive and overdose potential.