I'm surprised at the general dismissiveness and what ultimately amounts to inexperience at best and ignorance at worst. Middle insomnia is a separate and distinct type of insomnia. Although most people think of insomnia as late onset sleep caused by anxiety or caffeine, the presentation and causality of middle insomnia is often different. The patient has no trouble going to sleep and falling asleep at a regular time. The trouble is not only waking before the night and sleep is over, but falling back to sleep.
It could be caused by certain antidepressants, Parkinson's meds, and other similar treatments for chronic conditions. Therefore, a patient can't just take something like an Ambien at bedtime. Not only is it unnecessary but some of these patients are sensitive to hypnotics, get a hang over, are sensitive to dosages, and really don't need to shoot a target with a canon. For their needs, falling back asleep faster but for a shorter duration is just what they're looking for.
I guess since this kind of detailed info can't be memorized from a textbook or iPhone app and one is unlikely to come across this kind of dual diagnosis while doing clinical rotations it might not have occurred to some posting here. The reality is that although drug ever greening and such exists, if there's a new drug on the market it's because there's a significant patient population who needs it. Amitiza and Linzess aren't the same drug, for instance. And even if they appeared to be, each patient is going to have their own experience with a med, and the data is just going to show what it wants to.
