The findings do not "unequivocally tell us" if insomnia that accompanies depression is a symptom or a separate disorder, Pigeon's group maintains. The most likely scenario, they add, is that "insomnia is simply a symptom in some cases and clearly a disorder requiring its own treatment focus in other cases."
If medication is required to treat insomnia, Pigeon recommends the newer hypnotic drugs that have been shown to be safe and effective in elderly patients, such as Ambien, Lunesta and Sonata. If morning sedation is a concern, Rozarem may be a better option.
"Clearly, if there is no improvement in depression, a referral to a psychiatrist is indicated," Pigeon said. "When insomnia persists in the face of improvements in depression or when depression improves some but remains present with ongoing insomnia, the first consideration for a referral should be to a behavioral sleep medicine specialist."
SOURCE: Sleep, April 1, 2008.
