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REVIEW article

Front. Psychiatry
Sec. Psychological Therapy and Psychosomatics
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1490585
This article is part of the Research Topic Community Series in Psychocardiology: Exploring the Brain-Heart Interface, volume III View all 3 articles

Pharmacological and Psychological Approaches to Insomnia Treatment in Cardiac Patients: A Narrative Literature Review

Provisionally accepted
Britta Stapel Britta Stapel 1*Marlies Elizabeth Alvarenga Marlies Elizabeth Alvarenga 2Kai G. Kahl Kai G. Kahl 1
  • 1 Hannover Medical School, Hanover, Germany
  • 2 Federation University Australia, Ballarat, Australia

The final, formatted version of the article will be published soon.

    Sleep disorders are highly prevalent in the general population and are considered a major public health issue. Insomnia constitutes the most frequent sleep disorder in healthy individuals and has been shown to be even more frequent in patients with physical illnesses including cardiovascular diseases. Inadequate sleep quality and short sleep duration, independent of underlying causes, have been linked to the development and progression of cardiometabolic disorders. Additionally, insomnia has been found to be associated with adverse outcome measures, including daytime sleepiness, fatigue, decreased self-reported physical functioning, lower exercise capacity, poor health related quality of life, depressive symptoms, higher rates of hospitalization and increased mortality in patients with cardiovascular diseases.Against this background, comparatively little information is available in the literature regarding the treatment of chronic insomnia in cardiac patient populations. While guidelines for the general population suggest cognitive behavioural therapy for insomnia as a first-line treatment option and preliminary evidence suggests this treatment to be beneficial in cardiac patients with insomnia symptoms, it is often limited by availability and possibly the clinician’s poor understanding of sleep issues in cardiac patients. Therefore, pharmacologic treatment remains an important option indicated by the high number of hypnotic drug prescriptions in the general population and in patients with cardiovascular disorders.In this narrative review of the literature, we summarize treatment options for chronic insomnia based on clinical guidelines for the general population and highlight necessary considerations for the treatment of patients with cardiovascular diseases.

    Keywords: insomnia, cardiovascular disease, pharmacological treatment, benzodiazepine, orexin receptor antagonist, antidepressant, Z-drug, Melatonin

    Received: 03 Sep 2024; Accepted: 24 Jan 2025.

    Copyright: © 2025 Stapel, Alvarenga and Kahl. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Britta Stapel, Hannover Medical School, Hanover, Germany

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.