When a patient complains of poor sleep quality, even when sleeping 6-8 hours, what usually would be your first medication choice?

Choice of sleep med?: Assuming there is no rls, periodic limb movement disorder, or sleep apnea, then you have the following choices. If male and under the age of 65 choose Ambien 10 mg PO q hs. If female and under the age of 65 choose Ambien 5 mg nightly. If over the age of 65 i prefer to use Lunesta (eszopiclone) 2 mg PO qhs depending upon the age. Also please make sure that the patient is not experiencing a psychiatric disorder. If the above do not help i would recommend referral to a sleep specialist or a psychiatrist with experience with disorders. Greetings from racine.

Nothing yet: A sleep study would give you a better choice of therapies. Sleeping pills are usually not a great option.

Sleep study: I would have that patient checked for sleep apnea. CPAP may do better than any drug.

No meds yet: Need to DX why sleep quality so poor. Is it a metabolic problem a respiratory problem a GI problem, a psychiatric problems, a substance abuse problem, an environmental problems? Start with a detailed hx, labs, spirometry, order sleep study, depression screen etc.

Evaluate environment: Medicines should be used only after you assess the condition when you sleep. The initial assessment should include the quality of your environment to allow for undisturbed sleep fir 8 hours. Is it dark enough? Are there noises in the night that could disrupt the silence? Are there distractions - tv that is on? Pets bother you? Correct these issues, you may not even need medications.

Formal Evaluation: There is a strong possibility that the patient may have Sleep Apnea. Have then answer a Berlin Questionnaire to assess the possible likelihood. The can also do the Epworth Sleepiness Scale to document their degree of sleepiness. If they are at a high risk or excessively sleepy, they should have a sleep study done.