How do you sequence pharmacologic treatments for primary insomnia?  

First, be sure you have already addressed deficiencies in sleep hygiene: room at 65 degrees F. wearing earplugs complete darkness (no visible hand in front of face) no clock Golden hour before bed ETOH, nicotine, and caffeine reduction - with cessation 4 hrs before bed. writing list of worr...

I very seldom recommend medications. There is both physical dependency and psychological dependency (patients feeling they need to take something to sleep). I use sleep logs and establish sleep restrictions, e.g., 5 hours only in bed with no naps in the day. Dealing with cognitive distortions where ...

I had a good experience with prescribing orexin inhibitors Dayvigo as well as the new upcoming Quviviq as they block wakefulness and do not induce drowsiness. They may also have a good effect on reducing daytime sleepiness.

Sleep diary Sleep hygiene reinforcement GAD/Depression Screening  Discuss actigraphy, irregular sleep wake cycles, and sleep state misperception Trial of melatonin Sleep study (HST/Lab) Treat OSAS if present Trial of somnolence agent therapies