Management of insomnia: current trends

Insomnia is one of the most commonly occurring sleep disorders worldwide. With increased prevalence of insomnia the demand of the people seeking pharmacological treatment for this disease is continuously increasing. Numerous options are currently available for its treatment and with our increased understanding of the neurophysiological factors involved in the insomnia continuous research is being conducted to seek newer pharmacological treatments. Recent advancement in treatment of insomnia is the introduction of non-benzodiazepine hypnotic medications such as zaleplon, zolpidem, and eszopiclone. Ramelteon, a melatonin agonist, is also helpful for sleep initiation diffi culties. Tri-cyclic antidepressants have long been used for insomnia but use has been limited by unwanted anticholinergic side-effects. A hypocretin/orexin antagonist MK-4035 is presently in clinical trials. Serotonin antagonists and inverse agonists are being investigated for their usefulness in insomnia; newer research examining other mechanisms of action suggest that agents which modulate the histaminergic, serotonergic, melontonergic, and hypocretin/orexin and perhaps gamma-aminobutyric acid B systems could play a promising role in management of insomnia. [Int J Basic Clin Pharmacol 2014; 3(2.000): 272-276]