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The Rx Consultant 

Chronic Insomnia

This CE activity was originally published in The Rx Consultant.  If you received credit for it previously, you cannot receive credit for it again.

Insomnia is one of the most common medical complaints, generating over 5 million office visits per year in the US alone. Symptoms of insomnia occur in one-third to one-half of adults in the US, and are more prevalent among women and older adults.3-7 In patients with coexisting psychiatric illnesses, the incidence approaches 50% to 75%.3,8 About 1 in 10 adults has chronic insomnia – symptoms that occur at least 3 times per week for at least 3 months.9 Among patients with chronic insomnia, up to one-third suffer daytime consequences.

Although hypnotic medications have been considered the cornerstone of insomnia therapy for decades11, recent guidelines recommend cognitive behavioral therapy as the initial treatment for chronic insomnia. In the last 10 years, new drugs have entered the marketplace for insomnia treatment: a melatonin receptor agonist, ramelteon (Rozerem®), the orexin receptor antagonist, suvorexant (Belsomra®),12 and low-dose doxepin (SilenorTM). Over-the-counter medications (eg, antihistamines, melatonin supplements) and other prescription medications used off label are also sought-after remedies for insomnia.

This issue focuses on updated recommendations for the management of insomnia in adults. The importance of advocating for behavioral changes (sleep hygiene and stimulus control) prior to medication use is highlighted. The medications that may be used in addition to behavioral therapy are reviewed. When advising patients, providers should take an active role in discussing medication benefits and risks, including appropriate medication choice, duration of use, tolerance, side effect management, and drug interactions...

This CE activity is a monograph (PDF file).



CE Hours


CE Units


Activity Type

  • Knowledge

Target Audience(s)

  • Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, and Registered Nurses


This CE activity was developed by The Rx Consultant, a publication of Continuing Education Network, Inc.

CE activities for Pharmacists and Pharmacy Technicians:
This continuing education (CE) activity meets the requirements of all state boards of pharmacy for approved continuing education hours.  CE credit is automatically reported to CPE Monitor.
CE activities for Nurse Practitioners and Clinical Nurse Specialists: 
    This continuing education activity meets the requirements of:
        The American Nurses Credentialing Center (ANCC) for formally approved continuing education (CE) hours, and CE hours of pharmacotherapeutics.
        The American Academy of Nurse Practitioners Certification Program (AANPCP) for acceptable, accredited CE.
    This is a pharmacotherapeutics/pharmacology CE activity.
  • The ANCC requires all advanced practice nursing certificants (CNSs and NPs) to complete 25 CE hours of pharmacotherapeutics as a portion of the required 75 continuing education hours.
  • Pharmacology CE is recommended by the AANPCP and will be required for Certificants renewing certification starting January 2017.  
  • Most State Boards of Nursing require a minimum number of pharmacy contact hours to renew an advanced practice license.
Accreditation Council for Pharmacy Education
Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Requirements for CE Credit

To receive CE credit, the participant must read the monograph in its entirety, complete the online post-test and receive a score of 70% or greater, and complete the online evaluation.
Pharmacists and Pharmacy Technicians -
Be sure your profile has been updated with your NAPB e-profile # and birth date information BEFORE completing the online evaluation, or your credits cannot be reported to CPE Monitor.
Continuing pharmacy education credit is automatically reported to CPE Monitor once the post-test & evaluation are successfully completed.





  • Review the prevalence, pathophysiology, and consequences of insomnia.
  • Explain the recommendations and rationale for cognitive-behavioral therapy for insomnia. Be able to counsel patients regarding sleep hygiene tips, stimulus control measures, and potential problems with the use of OTC sleep medications.
  • Describe the efficacy, indications, side effects, and drug interactions of GABA-A receptor modulators (including benzodiazepines and Z-drugs), ramelteon, and suvorexant.
  • Discuss the role of antidepressants and antipsychotics in the treatment of insomnia.


Ericka L. Crouse, PharmD, BCPP, CGP, FASHP
Clinical Pharmacy Specialist - Psychiatry and a Clinical Associate Professor of Pharmacy, Virginia Commonwealth University Medical Center Ri

Brief Bio : Ericka L. Crouse, PharmD, BCPP, CGP, FASHP is a Clinical Pharmacy Specialist - Psychiatry and a Clinical Associate Professor of Pharmacy and Psychiatry at Virginia Commonwealth University Medical Center Richmond in Virginia.

Jennifer A. Reinhold, B.A., Pharm.D., BCPS, BCPP
Associate Professor of Clinical Pharmacy, University of Sciences in Philadelphia

Brief Bio : Jennifer A. Reinhold, B.A., Pharm.D., BCPS, BCPP is an Associate Professor of Clinical Pharmacy in the Department of Pharmacy Practice, University of Sciences in Philadelphia.
Disclosure : Dr. Reinhold reports no financial relationship with the manufacturer(s) or provider(s) of any commercial product(s) or service(s) that appears in this issue.

Activity Number


Release Date: Feb 23, 2017
Credit Expiration Date: Feb 23, 2020

CE Hours