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Nonorganic insomnia

Last edited: 4/14/2026

Overview

Nonorganic insomnia refers to sleep disturbances not attributable to a specific medical, psychiatric, or environmental cause, often characterized by difficulty initiating or maintaining sleep without underlying pathology 8.

Diagnosis

  • Clinical interview encompassing sleep and medical history 9
  • Exclusion of organic sleep disorders through appropriate diagnostic testing (e.g., polysomnography, sleep diaries) 9
  • Assessment for comorbid mental health conditions and lifestyle factors 8

    • Management

  • First-line treatments: Cognitive Behavioral Therapy for Insomnia (CBT-I) 8
  • Pharmacotherapy:
    • - Nonbenzodiazepine hypnotics (e.g., eszopiclone 2 mg nightly for up to 12 weeks) 24 - Caution with long-term use of benzodiazepines and other hypnotics due to risks of dependency and adverse effects 1714
  • Deprescribing efforts: Pharmacist consultation and patient education to reduce reliance on hypnotics in older adults 16

    • Special Populations

  • Elderly: Avoid long-term benzodiazepine use; consider CBT-I and nonbenzodiazepine hypnotics cautiously 171620
  • Comorbidities: Monitor for interactions and side effects, especially with polypharmacy 17

    • Key Recommendations

  • Prioritize Cognitive Behavioral Therapy for Insomnia (CBT-I) as first-line treatment for nonorganic insomnia (Evidence: Strong 8)
  • Limit the use of hypnotics, particularly benzodiazepines, in older adults to minimize risks of dependency and adverse events (Evidence: Moderate 17)
  • Implement deprescribing strategies with pharmacist involvement to reduce hypnotic medication use in elderly patients (Evidence: Moderate 16)

    • References

    1 Kimura T, Yamamoto K, Saeki R, Omura T, Yano I. Impact of the Medical Policy Intervention for Polypharmacy on Long-Term Prescriptions of Hypnotic Medications in Older Patients: An Interrupted Time-Series Analysis Using a Nationwide Claims Database in Japan. Geriatrics & gerontology international 2026. link 2 Wen Z, Liu X, Liu P. The Real-World Safety Profile of Temazepam: A 20-Year Pharmacovigilance Analysis Based on the Large-Scale FAERS Database. CNS neuroscience & therapeutics 2026. link 3 Wang B, Liu K, Shi H, Chen X, Qin X, Yao L et al.. A cross-sectional study of anesthesia medical staff's occupational and health status in nongovernment medical institutions in China. Journal of evaluation in clinical practice 2025. link 4 Sogawa R, Hatano M, Nishimura F, Nishi J, Matsuoka A, Shinada K et al.. Association Between Hypnotics, Accidents, and Injuries: A Study Based on the Adverse Drug Event Reporting Database in Japan. In vivo (Athens, Greece) 2025. link 5 McIntyre RS, Wong S, Kwan ATH, Rhee TG, Teopiz KM, Ho R et al.. Association between dual orexin receptor antagonists (DORAs) and suicidality: reports to the United States Food and Drug Administration Adverse Event Reporting System (FAERS). Expert opinion on drug safety 2025. link 6 Wu J, Zhou Y, Qiu L, Liu L, Wang F, Zhen L et al.. Safety profile of ramelteon from the perspective of physicians and pharmacists: a 20-year real-world pharmacovigilance analysis based on the FAERS database. BMC psychiatry 2025. link 7 Kozole Smid AK, Mlakar A, Štukovnik V. Toxicity of benzodiazepines in the treatment of insomnia disorders in older adults: a systematic literature review. Croatian medical journal 2024. link 8 Fornaro M, Caiazza C, De Simone G, Rossano F, de Bartolomeis A. Insomnia and related mental health conditions: Essential neurobiological underpinnings towards reduced polypharmacy utilization rates. Sleep medicine 2024. link 9 Riemann D, Espie CA, Altena E, Arnardottir ES, Baglioni C, Bassetti CLA et al.. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. Journal of sleep research 2023. link 10 Lin CY, Chiang CH, Tseng MM, Tam KW, Loh EW. Effects of quetiapine on sleep: A systematic review and meta-analysis of clinical trials. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology 2023. link 11 Tian Y, Vitiello MV, Wang H, Wang Y, Dong D, Xu H et al.. Risk of insomnia during COVID-19: effects of depression and brain functional connectivity. Cerebral cortex (New York, N.Y. : 1991) 2023. link 12 Liou YF, Li SF, Ho CC, Lee MW. Risk of insomnia and hypnotics use among emergency physicians. Industrial health 2021. link 13 Tamschick R, Navarini A, Strobel W, Müller S. Insomnia and other sleep disorders in dermatology patients: A questionnaire-based study with 634 patients. Clinics in dermatology 2021. link 14 Yamamoto M, Inada K, Enomoto M, Habukawa M, Hirose T, Inoue Y et al.. Current state of hypnotic use disorders: Results of a survey using the Japanese version of Benzodiazepine Dependence Self-Report Questionnaire. Neuropsychopharmacology reports 2021. link 15 Dholakia S, Balderas C, Fields B. A busy veteran with chronic insomnia disorder. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2020. link 16 Kuntz JL, Kouch L, Christian D, Hu W, Peterson PL. Patient Education and Pharmacist Consultation Influence on Nonbenzodiazepine Sedative Medication Deprescribing Success for Older Adults. The Permanente journal 2019. link 17 Brossoit RM, Crain TL, Leslie JJ, Hammer LB, Truxillo DM, Bodner TE. The effects of sleep on workplace cognitive failure and safety. Journal of occupational health psychology 2019. link 18 Bourcier E, Baptiste A, Borowik A, Zerbib L, Bonnet-Zamponi D, Tubach F et al.. Sedative-hypnotic initiation and renewal at discharge in hospitalized older patients: an observational study. BMC geriatrics 2018. link 19 Iaboni A, Bronskill SE, Reynolds KB, Wang X, Rochon PA, Herrmann N et al.. Changing Pattern of Sedative Use in Older Adults: A Population-Based Cohort Study. Drugs & aging 2016. link 20 Kao KY, Spitzmueller C, Cigularov K, Wu H. Linking insomnia to workplace injuries: A moderated mediation model of supervisor safety priority and safety behavior. Journal of occupational health psychology 2016. link 21 Lee KY, Chen PP, Tse LA. Insomnia and associated factors among anaesthetists in Hong Kong. Anaesthesia and intensive care 2013. link 22 Kucharczyk ER, Morgan K, Hall AP. The occupational impact of sleep quality and insomnia symptoms. Sleep medicine reviews 2012. link 23 Menkes DB, Shieffelbien LM, Huthwaite M. Hypnosedative access and risk of harm. The New Zealand medical journal 2011. link 24 Ancoli-Israel S, Krystal AD, McCall WV, Schaefer K, Wilson A, Claus R et al.. A 12-week, randomized, double-blind, placebo-controlled study evaluating the effect of eszopiclone 2 mg on sleep/wake function in older adults with primary and comorbid insomnia. Sleep 2010. link 25 Pickrell JE, Hosaka K, Jackson DL, Heima M, Kharasch E, Milgrom PM. Expanded studies of the pharmacokinetics and clinical effects of multidose sublingual triazolam in healthy volunteers. Journal of clinical psychopharmacology 2009. link 26 Wilhelm B, Kellert R, Schnell R, Lüdtke H, Petrini O. Lack of sedative effects after vespertine intake of oxazepam as hypnotic in healthy volunteers. Psychopharmacology 2009. link 27 Leger D, Metlaine A, Choudat D. Insomnia and sleep disruption: relevance for athletic performance. Clinics in sports medicine 2005. link 28 . Zolpidem: now classified as a psychotropic at risk of abuse. Prescrire international 2003. link 29 Bain KT, Weschules DJ, Knowlton CH, Gallagher R. Toward evidence-based prescribing at end of life: a comparative review of temazepam and zolpidem for the treatment of insomnia. The American journal of hospice & palliative care 2003. link 30 Ramesh M, Roberts G. Use of night-time benzodiazepines in an elderly inpatient population. Journal of clinical pharmacy and therapeutics 2002. link 31 Carding PN, Horsley IA, Docherty GJ. A study of the effectiveness of voice therapy in the treatment of 45 patients with nonorganic dysphonia. Journal of voice : official journal of the Voice Foundation 1999. link80063-0) 32 Opedal K, Schjøtt J, Eide E. Use of hypnotics among patients in geriatric institutions. International journal of geriatric psychiatry 1998. link1099-1166(1998120)13:12<846::aid-gps880>3.0.co;2-t) 33 Akerlund L. Averages of sound pressure levels and mean fundamental frequencies of speech in relation to phonetograms: comparison of nonorganic dysphonia patients before and after therapy. Acta oto-laryngologica 1993. link 34 Schwinghammer TL, Young BG, Hirsh JD. Triazolam use in a university medical center. American journal of hospital pharmacy 1992. link 35 Nicholson AN. Hypnotics and occupational medicine. Journal of occupational medicine. : official publication of the Industrial Medical Association 1990. link

    Original source

    1. [1]
      Impact of the Medical Policy Intervention for Polypharmacy on Long-Term Prescriptions of Hypnotic Medications in Older Patients: An Interrupted Time-Series Analysis Using a Nationwide Claims Database in Japan. — Kimura T, Yamamoto K, Saeki R, Omura T, Yano I Geriatrics & gerontology international (2026)
    2. [2]
      The Real-World Safety Profile of Temazepam: A 20-Year Pharmacovigilance Analysis Based on the Large-Scale FAERS Database. — Wen Z, Liu X, Liu P CNS neuroscience & therapeutics (2026)
    3. [3]
      A cross-sectional study of anesthesia medical staff's occupational and health status in nongovernment medical institutions in China. — Wang B, Liu K, Shi H, Chen X, Qin X, Yao L et al. Journal of evaluation in clinical practice (2025)
    4. [4]
      Association Between Hypnotics, Accidents, and Injuries: A Study Based on the Adverse Drug Event Reporting Database in Japan. — Sogawa R, Hatano M, Nishimura F, Nishi J, Matsuoka A, Shinada K et al. In vivo (Athens, Greece) (2025)
    5. [5]
      Association between dual orexin receptor antagonists (DORAs) and suicidality: reports to the United States Food and Drug Administration Adverse Event Reporting System (FAERS). — McIntyre RS, Wong S, Kwan ATH, Rhee TG, Teopiz KM, Ho R et al. Expert opinion on drug safety (2025)
    6. [6]
      Safety profile of ramelteon from the perspective of physicians and pharmacists: a 20-year real-world pharmacovigilance analysis based on the FAERS database. — Wu J, Zhou Y, Qiu L, Liu L, Wang F, Zhen L et al. BMC psychiatry (2025)
    7. [7]
      Toxicity of benzodiazepines in the treatment of insomnia disorders in older adults: a systematic literature review. — Kozole Smid AK, Mlakar A, Štukovnik V Croatian medical journal (2024)
    8. [8]
      Insomnia and related mental health conditions: Essential neurobiological underpinnings towards reduced polypharmacy utilization rates. — Fornaro M, Caiazza C, De Simone G, Rossano F, de Bartolomeis A Sleep medicine (2024)
    9. [9]
      The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. — Riemann D, Espie CA, Altena E, Arnardottir ES, Baglioni C, Bassetti CLA et al. Journal of sleep research (2023)
    10. [10]
      Effects of quetiapine on sleep: A systematic review and meta-analysis of clinical trials. — Lin CY, Chiang CH, Tseng MM, Tam KW, Loh EW European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology (2023)
    11. [11]
      Risk of insomnia during COVID-19: effects of depression and brain functional connectivity. — Tian Y, Vitiello MV, Wang H, Wang Y, Dong D, Xu H et al. Cerebral cortex (New York, N.Y. : 1991) (2023)
    12. [12]
      Risk of insomnia and hypnotics use among emergency physicians. — Liou YF, Li SF, Ho CC, Lee MW Industrial health (2021)
    13. [13]
      Insomnia and other sleep disorders in dermatology patients: A questionnaire-based study with 634 patients. — Tamschick R, Navarini A, Strobel W, Müller S Clinics in dermatology (2021)
    14. [14]
      Current state of hypnotic use disorders: Results of a survey using the Japanese version of Benzodiazepine Dependence Self-Report Questionnaire. — Yamamoto M, Inada K, Enomoto M, Habukawa M, Hirose T, Inoue Y et al. Neuropsychopharmacology reports (2021)
    15. [15]
      A busy veteran with chronic insomnia disorder. — Dholakia S, Balderas C, Fields B Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine (2020)
    16. [16]
      Patient Education and Pharmacist Consultation Influence on Nonbenzodiazepine Sedative Medication Deprescribing Success for Older Adults. — Kuntz JL, Kouch L, Christian D, Hu W, Peterson PL The Permanente journal (2019)
    17. [17]
      The effects of sleep on workplace cognitive failure and safety. — Brossoit RM, Crain TL, Leslie JJ, Hammer LB, Truxillo DM, Bodner TE Journal of occupational health psychology (2019)
    18. [18]
      Sedative-hypnotic initiation and renewal at discharge in hospitalized older patients: an observational study. — Bourcier E, Baptiste A, Borowik A, Zerbib L, Bonnet-Zamponi D, Tubach F et al. BMC geriatrics (2018)
    19. [19]
      Changing Pattern of Sedative Use in Older Adults: A Population-Based Cohort Study. — Iaboni A, Bronskill SE, Reynolds KB, Wang X, Rochon PA, Herrmann N et al. Drugs & aging (2016)
    20. [20]
      Linking insomnia to workplace injuries: A moderated mediation model of supervisor safety priority and safety behavior. — Kao KY, Spitzmueller C, Cigularov K, Wu H Journal of occupational health psychology (2016)
    21. [21]
      Insomnia and associated factors among anaesthetists in Hong Kong. — Lee KY, Chen PP, Tse LA Anaesthesia and intensive care (2013)
    22. [22]
      The occupational impact of sleep quality and insomnia symptoms. — Kucharczyk ER, Morgan K, Hall AP Sleep medicine reviews (2012)
    23. [23]
      Hypnosedative access and risk of harm. — Menkes DB, Shieffelbien LM, Huthwaite M The New Zealand medical journal (2011)
    24. [24]
      A 12-week, randomized, double-blind, placebo-controlled study evaluating the effect of eszopiclone 2 mg on sleep/wake function in older adults with primary and comorbid insomnia. — Ancoli-Israel S, Krystal AD, McCall WV, Schaefer K, Wilson A, Claus R et al. Sleep (2010)
    25. [25]
      Expanded studies of the pharmacokinetics and clinical effects of multidose sublingual triazolam in healthy volunteers. — Pickrell JE, Hosaka K, Jackson DL, Heima M, Kharasch E, Milgrom PM Journal of clinical psychopharmacology (2009)
    26. [26]
      Lack of sedative effects after vespertine intake of oxazepam as hypnotic in healthy volunteers. — Wilhelm B, Kellert R, Schnell R, Lüdtke H, Petrini O Psychopharmacology (2009)
    27. [27]
      Insomnia and sleep disruption: relevance for athletic performance. — Leger D, Metlaine A, Choudat D Clinics in sports medicine (2005)
    28. [28]
      Zolpidem: now classified as a psychotropic at risk of abuse. Prescrire international (2003)
    29. [29]
      Toward evidence-based prescribing at end of life: a comparative review of temazepam and zolpidem for the treatment of insomnia. — Bain KT, Weschules DJ, Knowlton CH, Gallagher R The American journal of hospice & palliative care (2003)
    30. [30]
      Use of night-time benzodiazepines in an elderly inpatient population. — Ramesh M, Roberts G Journal of clinical pharmacy and therapeutics (2002)
    31. [31]
      A study of the effectiveness of voice therapy in the treatment of 45 patients with nonorganic dysphonia. — Carding PN, Horsley IA, Docherty GJ Journal of voice : official journal of the Voice Foundation (1999)
    32. [32]
      Use of hypnotics among patients in geriatric institutions. — Opedal K, Schjøtt J, Eide E International journal of geriatric psychiatry (1998)
    33. [33]
      Averages of sound pressure levels and mean fundamental frequencies of speech in relation to phonetograms: comparison of nonorganic dysphonia patients before and after therapy. — Akerlund L Acta oto-laryngologica (1993)
    34. [34]
      Triazolam use in a university medical center. — Schwinghammer TL, Young BG, Hirsh JD American journal of hospital pharmacy (1992)
    35. [35]
      Hypnotics and occupational medicine. — Nicholson AN Journal of occupational medicine. : official publication of the Industrial Medical Association (1990)
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