Dr. Winkelman says a CPAP is like an arranged marriage. At first you are wondering who you are in bed with, but sometimes you end up falling in love.
Winkelman doesn’t think much of the purported differences between benzos and zolpidem/zaleplon. I miss grumpy expert psychiatrists who tell it like it is.
The orexin antagonists (suvorexant, lemborexant) work equal to zolpidem, very few side effects, scheduled but no evidence of abuse, good luck getting insurance to pay for them lol
Most commonly used meds in the US for chronic insomnia are sedating antidepressants, but there is almost no data about how well they work for chronic insomnia 🤷🏻♀️ (mirtaz/traz/ami/dox)
Just going to put in another plug for the CBTi app. In person works better but app is free. CBTi efficacy: decreases time spent awake in bed and increases sleep satisfaction but does not tend to increase total sleep time. 
For my clinicians out there, here’s a link to Winkleman’s nature neuropsychiatry review on insomnia from 2020 nature.com/collections/dd…
Winkelman is the only psychiatrist besides me I’ve heard of who has some reservations about melatonin in adolescents due to some possible interactions with the reproductive system. ❤️ ❤️ ❤️ psychologytoday.com/us/blog/evolut…
(I get some cranky clinician feedback for that article)
I’m not dead set against it but sometimes people use it like tik taks so…
https://twitter.com/evolutionarypsy/status/1403382440832520197
Tik tacks? Tic tacs
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