Researchers have identified two drugs – not currently licensed for treatment in the UK – that are better at treating insomnia in adults than other drugs.
The drugs, called eszopiclone and lemborexant, are better for both short- and long-term treatment of the condition, according to a new study from University of Oxford scientists.
However, the experts say the first line of treatment should still be cognitive behavioral therapy and improving sleep hygiene.
We hope that our analysis will be of great help to clinicians seeking the most appropriate treatment for their patients
This may include measures such as making sure the bedroom is a comfortable temperature and resting at least an hour before bedtime.
However, according to the researchers, the findings suggest that drugs may also be effective and should be used when needed.
Andrea Cipriani, Professor of Psychiatry at the University of Oxford and Honorary Counselor Psychiatrist at Oxford Health NHS Foundation Trust, said: “We hope our analysis will be of great help to clinicians seeking the most appropriate treatment for their patients.
“We looked at all published and unpublished information – in journals and in online registers – to get the most transparent and complete picture possible of all available data.
“Clearly, the need to treat insomnia as effectively as possible is very important, as it can have a knock-on effect on a patient’s health, his or her private life and the wider health system.
“This study of pharmacological treatments is not a recommendation that drugs should always be used as first-line support in the treatment of insomnia, not least because some of them can have serious side effects.
“However, our research shows that some of these drugs may also be effective and should be used in clinical practice, if needed.
“For example, where treatments such as improved sleep hygiene and cognitive behavioral therapy have not worked, or where a patient wants to consider taking medication as part of their treatment.”
According to the NHS, it is thought that a third of Britons will have insomnia at some point.
The researchers looked at data from 154 studies, including 44,000 people who were given either a placebo, a registered drug, or an unlicensed drug.
They analyzed the effectiveness of drugs to treat adults with insomnia, when the condition is not accompanied by a psychological comorbidity, such as depression or physical illness.
People were assessed for their sleep quality, the effects of treatment discontinuation, and the presence of any adverse reactions, such as dizziness, nausea, fatigue, headache, sedation, and somnolence.
Insomnia is defined as dissatisfaction with the amount or quality of sleep and is associated with at least three months of difficulty getting or staying asleep.
It affects up to 20% of the population and can persist for several years.
While the research showed that eszopiclone can be effective as a treatment for insomnia, it can also have significant side effects, such as dizziness and nausea.
Safety data on lemborexant were inconclusive, but did show a higher risk of causing headaches.
Other findings suggest that there was insufficient evidence to support the prescription of benzodiazepines and zolpidem in the long-term treatment of insomnia.
The study, published in The Lancet, was funded by the National Institute for Health and Care Research.