Journal ofClinical MedicineMDPIReviewAlliance for Sleep Clinical Practice Guideline on Switching orDeprescribing Hypnotic Medications for InsomniaNathaniel F.Watson 1,*,Ruth M.Benca 2,Andrew D.Krystal 3,William V.McCall 4 and David N.Neubauer 5Department of Neurology,University of Washington School of Medicine,Seattle,WA 98195,USA2 Department of Psychiatry and Behavioral Medicine,Wake Forest School of Medicine,Winston-Salem,NC 27101,USA3 Department of Psychiatry and Neurology,UCSF Weill Institute for Neurosciences,San Francisco,CA 94158,USA4Department of Psychiatry and Health Behavior,Medical College of Georgia,Augusta University,Augusta,GA 30912,USA5Department of Psychiatry and Behavioral Sciences,School of Medicine,Johns Hopkins University,Baltimore,MD 21218,USACorrespondence:nwatson@uw.eduAbstract:Determining the most effective insomnia medication for patients may require therapeutictrials of different medications.In addition,medication side effects,interactions with co-administeredmedications,and declining therapeutic efficacy can necessitate switching between different insomniamedications or deprescribing altogether.Currently,little guidance exists regarding the safest andmost effective way to transition from one medication to another.Thus,we developed evidence-basedguidelines to inform clinicians regarding best practices when deprescribing or transitioning betweeninsomnia medications.Five U.S.-based sleep experts reviewed the literature involving insomniamedication deprescribing,tapering and switching and rated the quality of evidence.They usedthis evidence to generate recommendations through discussion and consensus.When switching ordiscontinuing insomnia medications,we recommend benzodiazepine hypnotic drugs be taperedupdateswhile additional CBT-I is provided.For Z-drugs zolpidem and eszopiclone (and not zaleplon),especially when prescribed at supratherapeutic doses,tapering is recommended with a 1-2-day delayCitation:Watson,N.E;Benca,R.M.:in administration of the next insomnia therapy when applicable.There is no need to taper DORAs,Krystal,A.D.;MeCall,W.V;doxepin,and ramelteon.Lastly,off-label antidepressants and antipsychotics used to treat insomniaNeubauer,D.N.Alliance for Sleepshould be gradually reduced when discontinuing.In general,offering individuals a rationale forClinical Practice Guideline ondeprescribing or switching and involving them in the decision-making process can facilitate theSwitching or Depreseribing Hypnotiechange and enhance treatment success.Medications for Insomnia.I.Clint.Mad.2023,12,2493.https://doiorg/10.3390/1cm12072498Keywords:insomnia;insomnia medications;hypnotics;switching;deprescribingAcademie Editor.Marco ZaffanelloReceived:15 February 2023Revised:20 March 20231.IntroductionAccepted:21 March 2(23Insomnia,defined as difficulty falling or staying asleep or early morning awakening,Published:25 March 2023resulting in some form of daytime impairment,is the most common sleep disorder inadults,with a worldwide
