I think there's an analogy somewhere...Maybe: sleep drugs are like butt holes. Everyone has one and they all stink?
Mostly, it's the chronic use and rapid tolerance issue.
Well, there is suvorexant but I don't know anyone brave enough to try it with psych patients.
And when they do work, we're generally talking about reducing time to fall asleep, on the order of minutes.
So basically, we are palliating subjective poor sleep by treating it. Often the trade-off doesn't seem worth it.
Of course, sleep is critically important. To suicide risk, impact on mental illness symptoms, impact on physiologic wellness, impact on psychologic understanding of self. So important that insomnia is a supporting criteria for psychiatric admission for Medicare.
I don't find sleep hygiene education helpful usually. More helpful is normalizing expectations and placing emphasis on daytime functioning rather than subjective sleep quality.
CBT-Insomnia works, but good luck finding a patient who has the means or will follow-up with that recommendation. There are a couple of on-line courses I've recommended to some patients. None have done it that I know.
Then a host of actual sleep disorders that may be primary or comorbid. People tend to think about OSA, but my experience is the process of psychiatrist thinking "you may have sleep apnea" to patient getting CPAP fails far more often than not. Plus there's things like delayed sleep phase disorder where we end up mucking things up very often. Don't think we evaluate narcolepsy appropriately either, unless they present with cataplexy.
Would love to hear other experiences -- possibly just my training environment that mostly slings meds at it rather than universal experiences.
