AANP Family Nurse Practitioner (FNP) Certification ExamPlanMedium
A 48-year-old female presents with persistent insomnia for the past 3 months. She reports difficulty falling asleep and staying asleep, leading to daytime fatigue and impaired concentration. She has tried sleep hygiene measures without significant improvement. Her medical history is unremarkable, and she denies symptoms of depression or anxiety. Which of the following is the most appropriate initial pharmacological treatment?
- ATrazodone 50 mg at bedtime
- BZolpidem 10 mg at bedtime
- CMelatonin 3 mg at bedtime
- DDiphenhydramine 50 mg at bedtime
Show answer & explanationAnswer & explanation
Correct answer: B. Zolpidem 10 mg at bedtime
Zolpidem, a non-benzodiazepine hypnotic, is a common first-line pharmacological treatment for short-term insomnia due to its efficacy in promoting sleep onset and maintenance. It is generally preferred over benzodiazepines and sedating antidepressants for initial management of primary insomnia.
Why the other options are wrong
- A. Trazodone is an antidepressant with sedating properties, often used off-label for insomnia, but typically considered after non-benzodiazepine hypnotics or when co-morbid depression is present.
- C. Melatonin is a hormone that can help with sleep, particularly for circadian rhythm disorders, but its efficacy for chronic primary insomnia is generally modest and not considered a strong first-line pharmacological agent.
- D. Diphenhydramine is an antihistamine with sedating effects, but its anticholinergic side effects and risk of tolerance make it less ideal for chronic insomnia.
Insomnia Pharmacotherapy
Pharmacological treatment for insomnia involves selecting agents based on type of insomnia, comorbidities, and potential side effects.
- Non-benzodiazepine hypnotics (e.g., zolpidem) are often first-line for short-term insomnia.
- Sedating antidepressants (e.g., trazodone) may be used, especially with co-morbid depression.
- Antihistamines are generally not recommended for chronic insomnia due to side effects.
Memory trick: Zzzleep with Z-drugs first, then consider others!