What is your pharmacologic approach to treating insomnia comorbid with sleep apnea?

I do not usually treat any insomnia, regardless of comorbidities, with any targeted medication for the insomnia itself. If the patient is getting over 5 hours of sleep, then I use CBT-I as this is guideline-recommended (AASM) first-line treatment for insomnia and has efficacy lasting over a year out...

Start early, as it will increase the success of the patient starting PAP therapy. Medication may be of utility here in addition to CBT-I. Generally, pregabalin or a Z-drug is reasonable. Ramelteon has some irritability concerns that are undesirable. Antihistamines and trazodone either have a relativ...