New approaches in the treatment of short term and middle of the night insomnia: emerging evidence for a role for sublingual zolpidem tablets

Insomnia affects a significant proportion of the general population and an even greater proportion of patients seen in general medical care. Insomnia has multiple negative effects on health status, decreases quality of life, and is associated with increased health care costs. Current treatments for insomnia include pharmacologic and behavioral strategies. Pharmacologic treatments may be effective for short-term and middle-of-the-night (MOTN) insomnia, but the usefulness of many sleep medications is limited by the residual daytime sedation with which they are associated. This problem is especially important in the case of MOTN insomnia, when only a few hours may elapse between the time a patient takes the medication and when he or she must rise. The development of sublingual and low-dose formulations of zolpidem raises the possibility that pharmacologic therapy may allow patients with MOTN insomnia to be effectively treated with a decreased risk of residual daytime sedation. Current studies of this strategy are promising, and several formulations are in the process of being brought to market.