Pharmacologic treatment data from chronic insomnia studies and the application to individuals with acute insomnia, a narrative review

A variety of pharmacologic treatments are approved for insomnia, encompassing a range of mechanisms of action, including some treatments with published data in models of acute insomnia. However, most studies are conducted in individuals with chronic insomnia. Thus, it is unclear whether data from studies in individuals with chronic insomnia apply to individuals with acute insomnia symptoms. In this review, we discuss the generalizability of pharmacologic treatment data from chronic insomnia studies to individuals experiencing acute insomnia. Data from chronic insomnia treatment trials can be generalized to those with acute insomnia based on 1) the pathophysiology and evolution of insomnia and 2) data indicating medications effective for chronic insomnia are also effective for acute/induced insomnia. The pharmacologic management of acute insomnia should be based on a careful benefit-risk evaluation of each treatment option, data for acute insomnia or acute relief of chronic insomnia symptoms, and clinical practice guideline considerations. Given the limitations of available self-treatment options for acute insomnia symptoms, proven pharmacologic approaches are needed. Based on the available information, and the indications outlined in the United States (US) prescribing information, certain pharmacologic treatments are reasonable recommendations for treatment of acute insomnia.