{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:07:59Z","timestamp":1790014079653,"version":"4.0.1"},"reference-count":123,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,9,26]],"date-time":"2024-09-26T00:00:00Z","timestamp":1727308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>One-third to one-half of ambulatory care patients report insomnia. The objective of this clinical review is to detail the many causes and evidence-based treatment options for insomnia in outpatients and to recommend screening and summarize evidence for the place in therapy of prescription and nonprescription treatments.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Summary<\/jats:title>\n                  <jats:p>This work provides an overview of the literature on insomnia regarding causes, patient assessment, and nonpharmacological and pharmacological treatments. Patients who present with insomnia should be assessed for sleep apnea, restless legs syndrome, narcolepsy, and all contributing medications as well as medical, psychiatric, and substance use disorder diagnoses. The type of insomnia, namely difficulty falling asleep, difficulty maintaining sleep, and early morning awakening with resulting functional impairment, should be documented in addition to whether insomnia is short term or persistent. Cognitive behavioral therapy for insomnia (CBT-I) or digital CBT-I is first-line treatment for all patients with insomnia irrespective of the cause or type. Nonprescription treatments such as antihistamines or melatonin are for select populations. Prescription hypnotics are best utilized on an as-needed basis or for nightly use for less than 6 weeks. Z-hypnotics are safe and effective for insomnia in persons with depression or an anxiety disorder but should be avoided in older individuals or if there is respiratory or cognitive impairment. Orexin receptor antagonists are effective for sleep initiation and maintenance in healthy persons or if there is mild cognitive impairment, but they require further study in individuals with psychiatric and medical diagnoses. Trazodone is the most prescribed off-label treatment due to its efficacy for sleep initiation and maintenance and its lack of abuse potential.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Insomnia treatment should be guided by patient age, diagnoses, and type of insomnia. Pharmacological treatments should be used at the lowest effective dose for the shortest duration of time.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajhp\/zxae255","type":"journal-article","created":{"date-parts":[[2024,9,26]],"date-time":"2024-09-26T11:41:48Z","timestamp":1727350908000},"page":"265-284","source":"Crossref","is-referenced-by-count":2,"title":["Insomnia in ambulatory care: A clinical review"],"prefix":"10.1093","volume":"82","author":[{"given":"Julie A","family":"Dopheide","sequence":"first","affiliation":[{"name":"USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California , Los Angeles, CA"},{"name":"Keck School of Medicine, University of Southern California , Los Angeles, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winter R","family":"Roth","sequence":"additional","affiliation":[{"name":"USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California , Los Angeles, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle K L","family":"Chu","sequence":"additional","affiliation":[{"name":"USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California , Los Angeles, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,9,26]]},"reference":[{"issue":"3","key":"2025030717061172300_CIT0001","doi-asserted-by":"publisher","first-page":"ITC33","DOI":"10.7326\/AITC202103160","article-title":"Insomnia","volume":"174","author":"Sutton","year":"2021","journal-title":"Ann Intern Med"},{"issue":"23","key":"2025030717061172300_CIT0002","doi-asserted-by":"publisher","first-page":"2444","DOI":"10.1001\/jama.2021.19283","article-title":"What is insomnia","volume":"326","author":"Krystal","year":"2021","journal-title":"JAMA"},{"key":"2025030717061172300_CIT0003","doi-asserted-by":"publisher","DOI":"10.15620\/cdc:117490","volume-title":"Sleep Difficulties in Adults: United States, 2020","author":"Adjaye-Gbewonyo","year":"2022"},{"issue":"suppl 4","key":"2025030717061172300_CIT0004","doi-asserted-by":"publisher","first-page":"S91","DOI":"10.37765\/ajmc.2020.43008","article-title":"Economic burden and managed care considerations for the treatment of insomnia","volume":"26","author":"Dopheide","year":"2020","journal-title":"Am J Manag Care"},{"issue":"5","key":"2025030717061172300_CIT0005","doi-asserted-by":"publisher","first-page":"17m12020","DOI":"10.4088\/JCP.17m12020","article-title":"Insomnia and impaired quality of life in the United States","volume":"79","author":"Olfson","year":"2018","journal-title":"J Clin Psychiatry"},{"issue":"6","key":"2025030717061172300_CIT0006","doi-asserted-by":"publisher","first-page":"727","DOI":"10.5665\/sleep.1846","article-title":"Sleep: a health imperative","volume":"35","author":"Luyster","year":"2012","journal-title":"Sleep"},{"issue":"11","key":"2025030717061172300_CIT0007","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1176\/appi.ajp.2019.19030267","article-title":"Reducing suicidal ideation through insomnia treatment (REST-IT): a randomized clinical trial","volume":"176","author":"McCall","year":"2019","journal-title":"Am J Psychiatry"},{"key":"2025030717061172300_CIT0008","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/j.sleep.2019.07.016","article-title":"Sleep, suicide behaviors, and the protective role of sleep medicine","volume":"66","author":"Bishop","year":"2020","journal-title":"Sleep Med"},{"issue":"2","key":"2025030717061172300_CIT0009","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1124\/pr.117.014381","article-title":"Drugs for insomnia beyond benzodiazepines: pharmacology, clinical applications, and discovery","volume":"70","author":"Atkin","year":"2018","journal-title":"Pharmacol Rev"},{"key":"2025030717061172300_CIT0010","first-page":"1900","article-title":"Sleep disorders","volume-title":"Koda-Kimble & Young\u2019s Applied Therapeutics","author":"Dopheide","year":"2013","edition":"10"},{"key":"2025030717061172300_CIT0011","doi-asserted-by":"publisher","first-page":"101332","DOI":"10.1016\/j.smrv.2020.101332","article-title":"Effects of orexin receptor antagonism on human sleep architecture: a systematic review","volume":"53","author":"Clark","year":"2020","journal-title":"Sleep Med Rev"},{"issue":"2","key":"2025030717061172300_CIT0012","doi-asserted-by":"publisher","first-page":"255","DOI":"10.5664\/jcsm.8986","article-title":"Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline","volume":"17","author":"Edinger","year":"2021","journal-title":"J Clin Sleep Med"},{"key":"2025030717061172300_CIT0013","doi-asserted-by":"publisher","first-page":"101573","DOI":"10.1016\/j.smrv.2021.101573","article-title":"The efficacy and safety of dual orexin receptor antagonists in primary insomnia: a systematic review and network meta-analysis","volume":"61","author":"Xue","year":"2022","journal-title":"Sleep Med Rev"},{"key":"2025030717061172300_CIT0014","doi-asserted-by":"publisher","first-page":"e5861","DOI":"10.1002\/gps.5861","article-title":"Use of benzodiazepine and Z-drugs and mortality in older adults after myocardial infarction","author":"Liu","year":"2022","journal-title":"Int J Geriatr Psychiatry."},{"issue":"8","key":"2025030717061172300_CIT0015","doi-asserted-by":"publisher","first-page":"2933","DOI":"10.3390\/jcm12082933","article-title":"Should trazodone be first-line therapy for insomnia? 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