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Considerations regarding nonbenzodiazepine receptor agonists for sleep in children

Pros	Cons
Preparations available for either sleep-onset insomnia or sleep-maintenance insomnia Little effect on sleep architecture: Some SWS suppression Generally well tolerated (unpleasant taste, headache, anterograde amnesia, daytime drowsiness) Some preparations have limitations on duration of use Alternative formulations available (sublingual, oral spray)	Little empirical evidence of efficacy in children Uncommon but significant side effects Hallucinations Complex sleep-related behaviors (eg, sleepwalking or sleep driving)* Abrupt withdrawal with prolonged use (>2 weeks) may be associated with rebound
Bottom line – Lack of documented efficacy and sleep-related behavior side effects limit utility except in older adolescents.

SWS: slow-wave sleep.
* These complex sleep-related behaviors may result in serious injury and, in some cases, fatalities. These medications are contraindicated for any patient who has an episode of complex sleep-related behavior, whether or not it is triggered by the medication.

Courtesy of Judith A Owens, MD, MPH.

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