Insomnia Medications – 6.2 Nursing Pharmacology Review Course

Insomnia management prioritizes non-drug interventions, such as sleep hygiene, before transitioning to pharmacotherapy. While Z-drugs function as GABA agonists to aid sleep onset and maintenance, they carry significant risks of dependence, next-day impairment, and abnormal sleep behaviors. Antidepressants like trazodone and mirtazapine serve as alternatives, though mirtazapine's appetite-stimulating effects may be contraindicated for some patients. Conversely, first-generation anticholinergics—frequently hidden in over-the-counter "sleep" or "PM" products—pose substantial risks for older adults, including confusion and urinary retention. Clinicians must also identify medication-induced insomnia, particularly from corticosteroids and ADHD stimulants, which should be administered earlier in the day to mitigate sleep disruption. Effective treatment requires balancing therapeutic goals with the potential for adverse effects, especially in vulnerable populations.