If pharmacotherapy is considered, the ESRS points out that €there are significant placebo effects in clinical trials of pharmacological treatments for insomnia.€17

A meta-analysis of 32 studies with 3,969 participants published in 2015, €found that more than 60% of the response to medication (in most studies BZ [benzodiazepines] and BZRAs [benzodiazepine receptor agonists]) was also observed with placebo.€

The ESRS gives recommendations on sleep medications:17

·       benzodiazepines and BZRAs may be used in the short term if CBT-I is ineffective or unavailable (based on high-quality evidence)

·       benzodiazepines/BZRAs with shorter half-lives may reduce the risk of morning sedation side-effects (moderate-quality evidence)

·       long-term treatment of insomnia with benzodiazepines/BZRAs is not generally recommended; in patients using medication on a daily basis, reduction to intermittent dosing is strongly recommended;

·       some sedating antidepressants may be suitable for short-term use (moderate-quality evidence);

·       because of insufficient evidence, antihistamines and antipsychotics are not recommended for treating insomnia (strong recommendation €“ low- to very-low-quality evidence);

·       melatonin and phytotherapy (valerian, Chinese herbal medicines, and other plant-derived products) are not recommended for insomnia (weak recommendation €“ low-quality evidence);

·       light therapy and exercise regimes may be useful as adjunct therapies (weak recommendation, low-quality evidence).