Role of optimum diagnosis and treatment of insomnia in patients with hypertension and diabetes: A review

Sleep plays a pivotal role in regulation and function of the central nervous system (CNS) and other physiological functions of the body such as regulation of body temperature, metabolism, catabolism, learning, and memory consolidation. Therefore, sleep is not a mere passive state, but it is a highly organized interaction of neural networks and neurotransmitters of the CNS which maintain active neurobehavioral state. However, in insomnia normal physiological function is disturbed which results in several comorbidities such as depression, cardiovascular disorders, hypertension, diabetes mellitus, breathing difficulties, chronic pain, and gastrointestinal problems which affect the quality of life. Diagnosis of insomnia requires a comprehensive assessment of patient's medical history, physical examination, and sleeping pattern using various screen tools. There are several options available for the treatment of insomnia such as non-pharmacological and pharmacological that increase our understanding of the involvement of neurophysiological, neurobehavioral, neurochemical, neurocognitive, and neuroendocrine factors associated with insomnia. The pharmacological agents that are currently in use for the treatment of insomnia include benzodiazepines (BZDs), non-BZD hypnotics, and ramelteon as well as antidepressants such as doxepin. However, due to adverse events and addiction potential, use of BZDs is obsolete. Among non-BZD, zolpidem is the highly prescribed drug for the treatment of insomnia, globally. This review article focuses on prevalence, pathophysiology, diagnosis, and treatment of insomnia in patients with hypertension and diabetes. In addition, it also discusses the role of zolpidem in comparison to BZDs in the management of insomnia.