Insomnia and daytime sleepiness are extremely common. According to a survey by the National Sleep Foundation in 2001, 7% of Americans have drowsiness sufficient to interfere with normal activities on a daily basis, and another 14% experience this at least several times a week. Drowsiness can have serious health consequences as well; 1% of respondents in this same poll reported having automobile accidents because of falling asleep while driving. Sleep disorders are often not reported to physicians and are typically not a part of a routine evaluation.
Insomnia can consist of difficulty falling asleep, difficulty staying asleep, or both. There are many causes, but the most common are psychophysiological insomnia, primary insomnia. Insomnia also occurs commonly in the setting of medical and psychiatric illness. Depression and anxiety, both more common in patients with epilepsy, are frequently associated with insomnia. In this case, the best treatment is the treatment of the underlying condition although choice of sleeping drugs (if needed) can be influenced by coexisting problems.
The treatment of insomnia depends on the underlying cause. For short term insomnia (due to relocation or stress) no treatment may be required. Short acting sleeping agents can be used, the most common of which are zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta). Zaleplon is very short acting; so short in fact that patients can take another dose during the night and still wake up refreshed. Eszopiclone lasts longer than zolpidem, so may be better for people who wake up during the night, but is more likely to still be in the system the next morning with drowsiness. Benzodiazepines are also used commonly, although their tendency to disrupt sleep structure and the development of tolerance make these drugs less desirable. Most commonly used are temazepam (Restoril) and estazolam (Prosom). Rebound insomnia (worse sleep when stopping the drug) is more common with these. A number of antidepressant drugs can also be used for sleep. In general, the more sedating drugs (such as trazadone (Desyrel) taken at bedtime can be helpful even in the absence of depression.