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Sleep disorders: avoid medication if possible

Non-drug therapies should be offered as a first-line treatment for complaints of insomnia.

Poor sleep is sometimes due to non-medical causes (noise, cold, work schedules, etc.) and can be alleviated by attacking the cause, if possible. When a recent event interferes with sleep, certain herbal remedies (valerian infusions in particular) can be helpful.

In the case of ongoing sleep disorders, sleep counselling is useful (no stimulants before retiring, don't read or watch television in bed, etc.). A placebo or mild medication are also sometimes sufficiently effective.

If there is no improvement, behavioural therapy or even psychotherapy may be an option. When drug therapy seems unavoidable, sedatives should be prescribed sparingly, especially for the elderly, given the risk of adverse effects, particularly falls.

The best-evaluated drugs are short- or medium-acting benzodiazepines, at the minimum dose and for a short period. But it should be borne in mind that there is a risk of dependence and memory disorders, as well as withdrawal difficulties.

Non-drug therapies should be used for pregnant women in particular. If drug treatment is essential, doxylamine is the best option, but should be avoided in late pregnancy. Benzodiazepines should be avoided in both the late and early stages of pregnancy, due to the potential risk of foetal malformation.

©Prescrire February 2008

Source: "Plaintes de mauvais sommeil" Rev Prescrire 2008 ; 28 (292) : 111-118.

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