Optimizing Treatment for Insomnia
Dr Krystal describes a new paradigm for managing insomnia in which clinicians can select interventions that best target the sleep problem of each patient. The result is an improved risk-benefit ratio.
By tailoring the mechanism of action and effects of therapy to the specific nature of each patient’s insomnia and other conditions, clinicians can offer personalized care in an attempt to achieve an improved risk-benefit ratio compared to that of a “one-size-fits-all” treatment strategy. To move toward this personalization and optimization of treatment, clinicians need awareness of the specific effects of interventions and the subpopulations with insomnia who would benefit from each intervention. This report reviews insomnia treatments, focusing on effects associated with mechanism of action.
From the Series: Current Management Approaches for Insomnia
To cite: Krystal A. Optimizing treatment for insomnia. J Clin Psychiatry. 2021;82(4):EI20008BR4C.
To share: https://doi.org/10.4088/JCP.EI20008BR4C
© Copyright 2021 Physicians Postgraduate Press, Inc.
- Psychiatrists, Primary Care Clinicians, and Neurologists
- Nurse Practitioners & Physician Assistants in psychiatry, primary care, and neurology settings
Develop an effective evidence-based treatment plan for patients with insomnia
Supported by an educational grant from Eisai Inc.
After completing this educational activity, you should be able to:
- Develop an effective evidence-based treatment plan for patients with insomnia
Release, Review, and Expiration Dates
This brief report activity was published in June 2021 and is eligible for AMA PRA Category 1 Credit™ through June 30, 2023. The latest review of this material was June 2021.
Statement of Need and Purpose
Clinicians are not vigilant enough in documenting patients’ sleep histories. Because insomnia frequently accompanies psychiatric or medical illnesses and has a variety of negative consequences, clinicians must routinely screen patients for sleep-onset or sleep-maintenance insomnia. Therefore, education is needed to address clinicians’ incomplete understanding and assessment of insomnia. In addition, many clinicians are failing to provide recommended treatments for insomnia because they have reservations about the safety and appropriateness of some agents. Lack of understanding about the differences between treatments can prevent them from explaining and providing insomnia treatment options to patients. Education for clinicians about both approved and unapproved treatments is warranted to improve their management of insomnia. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on insomnia.
Disclosure of Off-Label Usage
Dr Krystal has determined that, to the best of his knowledge, trazodone, mirtazapine, amitriptyline, quetiapine, olanzapine, risperidone, lurasidone, and melatonin are not approved by the US Food and Drug Administration for the treatment of insomnia.
The faculty member(s) agreed to provide a balanced and evidence-based presentation and discussed the topic(s) and CME objective(s) during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.
This activity is derived from the teleconference series “Current Management Approaches for Insomnia,” which was held in June, September, and October 2020 and supported by an educational grant from Eisai Inc. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter..
Andrew D. Krystal, MD
Department of Psychiatry and Behavioral Sciences, University of California San Franscisco
The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:
Dr Krystal is a consultant for Adare, Axsome Therapeutics, Big Data, Eisai, Evecxia Therapeutics, Ferring, Galderma, Harmony Biosciences, Idorsia, Janssen, Jazz, Millenium, Merck, Neurocrine Biosciences, Pernix Therapeutics, Otsuka, Sage Therapeutics, and Takeda and has received grant/research support from Janssen, Axsome Therapeutics, Reveal Biosensors, The Ray and Dagmar Dolby Family Fund, and the National Institutes of Health.
The Chair for this activity, Russell P. Rosenberg, PhD, is a consultant and member of the speakers/advisory boards for Jazz, Eisai, and Harmony BioSciences and has received grant/research support from Jazz, Eisai, and Avadel.
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation