Individualizing therapy for early, middle-of-the-night and late-night insomnia

Many patients with insomnia describe their sleep problems as an inability t o remain asleep throughout the night, resulting in next-day fatigue that ma y adversely affect daytime functioning. To be most effective, insomnia trea tment should be tailored to resolving underlying causes of the condition an d managing specific sleep complaints. Therefore, hypnotic therapy administe red prior to bedtime, as is currently recommended for most compounds, is no t appropriate for all insomnia patients. Ideally, behavioral interventions should be combined with a rapid-acting agent that can be administered at vi rtually any time during the night without producing residual effects the fo llowing day. Zaleplon, a new nonbenzodiazepine sleep medication, provides t he clinician with an effective and safe pharmacotherapeutic option for inso mnia management. Its rapid rates of absorption and elimination allow for tr eatment of symptoms when they occur, either at bedtime or later at night, w ithout incurring significant risk for the development of next-day impairmen t of psychomotor and cognitive functioning.