Management of insomnia in India: expert consensus insights with a focus on zolpidem

Insomnia is a global health concern affecting 10%-30% of the population. In India, the prevalence of insomnia among adults is 33%, with older adults being notably affected - urbanization, lifestyle changes, and increasing stress levels are factors that lead to insomnia. Despite its widespread impact, few people affected by insomnia seek treatment due to societal stigma and sparse data on the disorder. Benzodiazepines (BDZs), particularly alprazolam, which were once favored for insomnia treatment, are no longer recommended due to side effects, including addiction and dependence risks. Zolpidem, a selective agonist of BDZ (ω) receptors containing α-1 subunits, has emerged as a viable alternative, often used in conjunction with cognitive behavioral therapy (CBT). Currently, zolpidem is the preferred first-line pharmacotherapy for the treatment of insomnia as it does not alter sleep architecture, prevents daytime sleepiness, has a non-addictive nature, and its abrupt discontinuation does not induce dependence, withdrawal symptoms, or trigger rebound insomnia. This expert opinion manuscript aims to elucidate the treatment landscape for insomnia in India, with a focus on the use of zolpidem. Insights were derived from advisory board meetings involving 33 Indian physicians from diverse specialties. Discussions centered on the current status of insomnia in India, clinical experiences with zolpidem, and emerging pharmacotherapeutic options. In conclusion, valuable insights into the management of insomnia and related disorders, with a focus on pharmacotherapy using zolpidem, were gained. Zolpidem provides effective treatment when compared with BDZs and other drugs. However, it must be prescribed judiciously based on patient-specific factors.