Daytime impairments in cognitive functioning and alertness can compromise work performance and increase the risk of motor vehicle crash. Sleep affects nearly every aspect of human physiology, and when compromised by insomnia, it can have broad untoward effects on human health, functioning, and quality of life. Insomnia, defined as difficulty falling or staying asleep or early morning awakening, resulting in some form of daytime impairment, is the most common sleep disorder in adults, with a worldwide prevalence of 10–30%. In general, offering individuals a rationale for deprescribing or switching and involving them in the decision-making process can facilitate the change and enhance treatment success. Lastly, off-label antidepressants and antipsychotics used to treat insomnia should be gradually reduced when discontinuing. There is no need to taper DORAs, doxepin, and ramelteon. For Z-drugs zolpidem and eszopiclone (and not zaleplon), especially when prescribed at supratherapeutic doses, tapering is recommended with a 1–2-day delay in administration of the next insomnia therapy when applicable. When switching or discontinuing insomnia medications, we recommend benzodiazepine hypnotic drugs be tapered while additional CBT-I is provided. They used this evidence to generate recommendations through discussion and consensus. Five U.S.-based sleep experts reviewed the literature involving insomnia medication deprescribing, tapering, and switching and rated the quality of evidence. Thus, we developed evidence-based guidelines to inform clinicians regarding best practices when deprescribing or transitioning between insomnia medications. Currently, little guidance exists regarding the safest and most effective way to transition from one medication to another. In addition, medication side effects, interactions with co-administered medications, and declining therapeutic efficacy can necessitate switching between different insomnia medications or deprescribing altogether. Determining the most effective insomnia medication for patients may require therapeutic trials of different medications.
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