Issues in the use of benzodiazepine therapy.

In selecting a hypnotic for the symptomatic management of insomnia, clinicians should look for those that most favorably balance sleep induction and sleep maintenance with potential adverse side effects. While all benzodiazepines have demonstrated efficacy in nocturnal sedation, the side effects of different compounds--and different doses of the same compound--vary greatly. The most common adverse effects associated with benzodiazepines are residual sedation, anterograde amnesia, and rebound insomnia, which are also related to the insomnia complaint itself. Therefore, careful evaluation of the dose of a benzodiazepine hypnotic is the key to effective treatment of insomnia without inducement of adverse effects. The most common side effects of hypnotics and their relation to drug dose are reviewed.