MANAGEMENT OF INSOMNIA: NON-PHARMACOLOGICAL AND PHARMACOLOGICAL APPROACHES

Aleksandra Marek; Krzysztof  Jamroch; Katarzyna Garncarz; Zofia  Nowakowska; Wiktoria Dybizbańska; Karolina  Dziki; Maciej Komenda; Mateusz Kacalak; Agnieszka Burzej; Julia Szklarska-Komenda

doi:10.31435/ijitss.1(49).2026.4606

Authors

Aleksandra Marek Central Teaching Hospital of the Medical University of Lodz, Łódź, Poland https://orcid.org/0009-0002-3391-5082
Krzysztof Jamroch 5th Military Clinical Hospital with Polyclinic SPZOZ, Kraków, Poland https://orcid.org/0009-0003-2562-1276
Katarzyna Garncarz 5th Military Clinical Hospital with Polyclinic SPZOZ, Kraków, Poland https://orcid.org/0009-0001-7554-2715
Zofia Nowakowska Upper Silesian Medical Center of the Medical University of Silesia in Katowice, Katowice, Poland https://orcid.org/0009-0000-8030-7341
Wiktoria Dybizbańska Independent Public Healthcare Institution of the Ministry of the Interior and Administration in Kraków, Kraków, Poland https://orcid.org/0009-0000-9899-7272
Karolina Dziki 5th Military Clinical Hospital with Polyclinic SPZOZ, Kraków, Poland https://orcid.org/0009-0005-1720-3810
Maciej Komenda 105th Military Hospital SP ZOZ in Żary, Żary, Poland https://orcid.org/0009-0009-7327-417X
Mateusz Kacalak The Nicolaus Copernicus Provincial Multispecialty Center for Oncology and Traumatology in Łódź, Łódź, Poland https://orcid.org/0009-0006-3386-0906
Agnieszka Burzej 5th Military Clinical Hospital with Polyclinic SPZOZ, Kraków, Poland https://orcid.org/0009-0003-0066-3197
Julia Szklarska-Komenda 105th Military Hospital SP ZOZ in Żary, Żary, Poland https://orcid.org/0009-0000-9914-4917

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.4606

Keywords:

Insomnia, CBT-I, Melatonin, Benzodiazepine Receptor Agonists, Trazodone

Abstract

Insomnia is a prevalent and persistent sleep disorder associated with significant impairments in daytime functioning, quality of life, and long-term health. It frequently co-occurs with mental and somatic conditions, yet requires independent diagnosis and targeted treatment. This review synthesizes current evidence on non-pharmacological and pharmacological therapies for insomnia across various populations. Cognitive Behavioral Therapy for Insomnia (CBT-I) remains the first-line treatment, supported by robust evidence demonstrating improvements in sleep onset, sleep maintenance, and daytime functioning. Core components, including stimulus control, sleep restriction, cognitive restructuring, relaxation techniques, and sleep hygiene, address the behavioral and cognitive mechanisms that sustain insomnia. CBT-I is effective in adults, older adults, adolescents, and perinatal populations, and often outperforms pharmacological interventions in long-term outcomes, although more research is needed to quantify sustained benefits.

Pharmacological options are typically reserved for short-term or adjunctive use. Benzodiazepine receptor agonists provide modest, transient benefits but carry substantial risks such as dependence, cognitive impairment, and falls, particularly in older adults. Safer alternatives include melatonin, melatonin receptor agonists such as ramelteon, and dual orexin receptor antagonists, which offer improved sleep quality with favourable safety profiles. Off-label agents, including low-dose doxepin, trazodone, hydroxyzine, and quetiapine, show variable efficacy and require cautious use due to limited long-term data and potential adverse effects. Special considerations apply to older adults, children, and pregnant or postpartum women, for whom behavioural interventions remain the preferred approach. Contemporary evidence supports a shift toward behavioural treatments, individualized care, and reasonable short-term medication use to reduce the clinical and societal burden of insomnia.

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