Introduction: is the quantity, quality, time or rhythm of sleep disorders. Sleep disorders disorders include insomnia, episodic sleeping sickness, obstructive sleep apnea syndrome, restless legs syndrome and so on. This article describes the pharmacologic treatment of insomnia. Clinical manifestations It is more common in women and the elderly. There are four types of insomnia: 1, difficulty falling asleep; 2, sleep maintenance disorders, easy to wake up; 3, early waking (after waking up can not go back to sleep); 4, poor quality of sleep, the next morning after waking up is still sleepy, no sense of energy recovery. Most of the patients have anxiety due to excessive concern about their own sleep problems, and experience nervousness, uneasiness, depressed mood, and in severe cases, symptoms of autonomic disorders such as accelerated heart rate, increased body temperature, and peripheral vasoconstriction. Anxiety may aggravate insomnia, leading to a vicious cycle of symptoms. Treatment 1, the overall goal of treatment: to clarify the cause of the disease as far as possible, improve the quality of sleep and/or increase the effective time of sleep; to restore social function and improve the quality of life of the patients; to reduce or eliminate the risk of insomnia-related physical diseases or co-morbidities with physical diseases; and to avoid the negative effects of drug interventions. 2.Non-pharmacological treatment (1)Sleep hygiene education (2)Relaxation therapy (3)Behavioral treatment (4)Cognitive and behavioral therapy 3.Pharmacological treatment (1)Benzodiazepine agonists ①Benzodiazepines include diazepam (Valium), clonazepam (Librium), nitrazepam (Nitrozepine), and eszopiclone (Xylazine), etc. BZDs are used for the treatment of insomnia by non-selectively agonizing the gamma aminobutyric acid receptor A ( GABAA). BZDs work by non-selectively agonizing different α-subunits on γ-aminobutyric acid receptor A ( GABAA), and have pharmacological effects such as hypnosis, anxiolysis, antispasmodic and muscle relaxation. It can shorten the duration of sleep, reduce the duration and number of awakenings, and increase total sleep time. Adverse effects include daytime sleepiness, dizziness, decreased muscle tone, falls and cognitive impairment. (2) Non-benzodiazepines Drugs include zolpidem, bitartan controlled release, zolpidem, dexzopiclone, and zaleplon compared with BZDs, so the newer non-benzodiazepines have only a single hypnotic effect, with no muscle relaxant or anticonvulsant effects. (2) Melatonin and melatonin receptor agonists Melatonin is involved in the regulation of the sleep-wake cycle and can improve symptoms of jet lag, delayed sleep phase syndrome and circadian rhythm disordered sleep. It can be used in the elderly population due to minimal adverse effects and is also used for jet lag. Melatonin receptor agonists include ramelteon and agomelatine. Rimelteon is currently the clinically used melatonin receptor MT1 and MT2 agonist, which can shorten sleep latency, improve sleep efficiency, and increase total sleep time, and can be used to treat insomnia with complaints of difficulty in falling asleep, as well as circadian rhythm disorder sleep disorders. It has been approved for the long-term treatment of insomnia due to the lack of drug dependence and the absence of withdrawal symptoms. Agomelatine is both a melatonin receptor agonist and a 5-hydroxytryptamine receptor antagonist, and therefore has both antidepressant and hypnotic effects, improving insomnia associated with depressive disorders and shortening sleep latency. Increase sleep continuity. 3, antidepressants Insomnia accompanied by anxiety, depressed state of mind when applied. Small-dose doxepin, selective 5-hydroxytryptamine reuptake inhibitors, small-dose mirtazapine antidepressants and BZRAs are used in combination to improve patient compliance. For example, the combination of zolpidem and paroxetine provides rapid relief of insomnia and synergistic improvement of depression and anxiety. Rational application of anti-insomnia drugs (1) Grasp the balance of benefits and risks When choosing intervention drugs, it is necessary to consider the relevance of symptoms, previous drug reactions, general condition of the patient, current drug interactions, adverse drug reactions, and other existing diseases. The principle of individualization also needs to be taken into account while following the principles of treatment. (2) Pay attention to drug dependence and drug withdrawal rebound As long-term use of the drug will have drug dependence and drug withdrawal rebound, in principle, the use of the lowest effective dose, intermittent administration (2 to 4 times per week), short-term administration (regular use of drugs not more than 3 to 4 weeks), slow reduction and gradual withdrawal (25% of the original drug every day). (3) The drug treatment strategy for insomnia is: (1) when insomnia is secondary to or associated with other diseases, the primary or associated diseases should be treated at the same time; (2) the patient’s response to treatment should be monitored and evaluated after the start of drug treatment. Long-term and refractory insomnia should be treated under the guidance of a specialist; ③ Short-acting BZRAs are preferred for primary insomnia, such as zolpidem, zopiclone, dexzopiclone, and zaleplon; ④ If the preferred medication is ineffective or cannot be adhered to, it should be replaced by another short- to medium-acting BZRA or melatonin agonist; ⑤ BZRAs or melatonin agonists can be used in combination with antidepressants; ⑤ BZRAs or melatonin agonists can be used in combination with antidepressants. antidepressants; ⑤ BZRAs or melatonin receptor agonists can be used in combination with antidepressants; ⑥ For patients with chronic insomnia who have applied sedative-hypnotic drugs for a long period of time, continuous drug treatment is not advocated, and it is recommended that intermittent or on-demand treatment be used for the administration of drugs. (4) Elderly insomnia patients preferred non-pharmacological treatment means. Elderly insomnia patients are recommended to use non-BZDs or melatonin receptor agonists. Caution should be exercised when using BZDs. If ataxia, blurred consciousness, paradoxical movements, hallucinations, respiratory depression occurs, the drug should be stopped immediately and handled appropriately, and attention should be paid to accidental injuries such as falls. Starting from the smallest effective dose, short-term application or use of intermittent therapy, do not advocate the administration of large doses of drugs, the use of drugs need to be closely observed in the process of adverse drug reactions. (5) Drugs for women during pregnancy There is a lack of information on the safety of sedative-hypnotic drugs for women during pregnancy. The use of sedative-hypnotic drugs and antidepressants during breastfeeding should be cautious to avoid the drugs affecting the baby through breast milk. Non-pharmacologic interventions are recommended for the treatment of insomnia. (6) For perimenopausal and menopausal women with insomnia, the common diseases affecting sleep in this age group, such as depression, anxiety and sleep apnea syndrome, should be identified and treated first, and the necessary hormone replacement therapy should be given according to the symptoms and hormone levels, and the treatment of insomnia in this part of the patient is the same as that of ordinary adults. (7) Patients with respiratory diseases BZDs are used with caution in patients with chronic obstructive pulmonary disease and sleep apnea hypoventilation syndrome due to adverse effects such as respiratory depression.Non-BZDs have strong receptor selectivity and low incidence of residual effects in the next morning, and no respiratory adverse effects have been found in patients with insomnia with mild to moderate COPD who are using zolpidem and zopiclone to treat the stabilized stage. reported, but the efficacy of zaleplon in insomnia patients with respiratory disease has not been established. BZDs are contraindicated in patients with acute exacerbation of COPD with significant hypercapnia and in the decompensated phase of restrictive ventilatory dysfunction, and can be applied along with mechanical ventilation support (invasive or noninvasive) and closely monitored if necessary. (8) Patients with co-morbid psychiatric disorders Insomnia symptoms are often present in patients with psychiatric disorders, and should be treated and controlled by a licensed psychiatrist in accordance with the principles of specialization for the treatment and control of primary illnesses, as well as the treatment of insomnia symptoms. (9) Depressive disorders are often co-morbid with insomnia, and insomnia should not be treated in isolation to avoid entering a vicious circle. It should be noted that the use of antidepressants and hypnotic drugs may aggravate sleep apnea syndrome and periodic leg movements. When insomnia exists in patients with anxiety disorders, anti-anxiety drugs are the mainstay, and sedative-hypnotic drugs are added at bedtime if necessary. When insomnia exists in patients with schizophrenia, antipsychotic medication should be chosen as the main treatment, supplemented by sedative-hypnotic medication for insomnia if necessary. Medication precautions and patient education 1. Before treatment, inform patients and their families about the nature of the drugs, their effects, possible adverse reactions and countermeasures. During the treatment, closely observe the changes in condition and adverse reactions. The necessity of treatment should be assessed regularly when long-term medication is used. Regular monitoring of blood counts, liver and kidney functions is needed in the initial and long-term treatment. 2, the drug can cause drowsiness, should be used with caution when engaged in driving, instrument operation or other operations that require concentration to complete, to avoid accidents. 3, can not be used in excess, should avoid and alcohol or other drugs that can cause drowsiness. 4, long-term application of benzodiazepines can not be suddenly stopped, because there is a risk of symptomatic rebound and withdrawal syndrome. 5.Patients and their families should be alert to the emergence of abnormal behavior, deterioration of the patient’s condition or suicidal tendencies. Once they appear, they should seek immediate medical attention.