Experts discuss treatment for patients experiencing insomnia in conjunction with other health conditions.
Paul Doghramji, MD, FAAFP: For most patients with insomnia comorbidities, whether they’re medical or psychiatric—some psychiatric disorders may even be addiction—do you recommend when you’re treating somebody with insomnia to first treat their comorbidity? Or do you suggest using or treating the insomnia at the same time that you treat a comorbidity?
Leslie Citrome, MD, MPH: This often comes up for the treatment of not only insomnia disorder but also, believe it or not, depression and psychosis. People say, “They’re using street drugs, and we can’t treat them unless they become clean.” I don’t think that’s the right approach. You need to treat the psychosis, you need to treat the mood disorder, you need to treat the insomnia; otherwise, you’re never going to be able to address anything else in that person’s life.
Paul Doghramji, MD, FAAFP: It’s really important, a lot of times, to treat the insomnia and the comorbidity at the same time. An antidepressant and an insomnia medication together would not be a bad idea. Is that correct?
Leslie Citrome, MD, MPH: I do that all the time. In the old days, all I had were traditional hypnotics, but I used them with some trepidation. I didn’t want them to use it every night because that could be problematic. They stop working if they’re taken nightly. The development of tolerance is very real, and ultimately patients take more than what they originally started to take, and it still doesn’t work after a little while. When it’s time to stop, it takes a long time, gradually decreasing the dose over weeks.
Transcript edited for clarity