Sleep Medications Treatment Tier List: Best Insomnia Medications Ranked

Okay.

Um, what is...

I'm gonna try to pick from this broad list of things that we have an S tier and the best one I can think of.

And honestly-- Oh, actually, I always do this.

[laughs] Before I actually pick anything, there is one thing I wanna emphasize.

What do we mean when we talk about the treatment of sleep? Uh, for us, this has to be the treatment of sleep specifically in people with psychiatric conditions of any kind.

Okay.

Uh, a lot of the people out there, including psychiatrists on the internet and off of the internet, they really love evidence, okay? They love to talk about the evidence and the studies, but evidence and studies is no substitute for your clinical decision-making and your ability to think rationally, okay? Uh, a study is very constrained, and so when we look at sleep society guidelines, they are based on studies and selected studies, and if you look at those studies, they almost universally exclude psychiatric patients.

If you can meet DSM criteria for a psychiatric disorder, you are excluded from the sleep medication studies.

So in my opinion, those guidelines are nearly worthless when it comes to the treatment of psychiatric conditions.

So in terms of, I guess, a little bit of context to what you're saying, the American Sleep Association has, uh, recommendations for sleep medications, and the medications that they push are mostly, I think, the Z drugs.

Uh, doxepin gets a big sign-off from them, which we'll talk about doxepin later.

But the recommendations from the American Sleep Association versus what we see in actual practice are wildly different.

And I think, to your point, it's not because people aren't reading the guidelines or that people are doing bad medicine.

Uh, there's, there's a good reason that we're not following these, these guidelines.

Mm-hmm.

Um, and following these guidelines, if you start using Z drugs first line for insomnia, you're gonna get into a whole host of problems.

Well, maybe you're not.

Your patients are gonna love you, and then you can send them to the next person that has to fix the, uh, Z drug dependence.

But anyway, okay, enough about that.

What is my number one pick out of this wide list for top one? It doesn't mean it's the only thing that you have to do to treat sleep, okay? But my number one pick is strict waking time.

Let's go and put that one into the S tier.

You have it on the second row.

It's in orange.

There it is.