Because sleep disturbances may be the presenting manifestation of a physical and/or psychiatric disorder, symptomatic treatment of insomnia should be initiated only after a careful evaluation of the patient. The failure of Insomnia to remit after 7 to 10 days of treatment may Indicate the presence of a primary psychiatric and/or medical illness that should be evaluated. Worsening of insomnia or the emergence of new thinking or behavior abnormalities may be the consequence of an unrecognized psychiatric or physical disorderMy history with sleep is complex as I have never been good at is since I was 3 days old. If I am depressed or manic it gets worse; when I do well and my meds are right it stays pretty good, or at least it has for the last few weeks. Back when I was undiagnosed and appeared to just have major depression that flared up with insomnia every so often I usually was treated first for sleep. That is how I've been on ambien so many times and at such doses that it just doesn't work for me. Maybe a few days, but that's it. I can't remember how many years it has been since ambien even worked for a week. To make this worse in grad school I convinced the psychiatrist to use ambien rather than antidepressants unless I was clearly depressed, not just in the early stage of it, insomnia. So I used it a good bit back then.
I remember that psychiatrist once talking about referring me to a neurologist with sleep specialization. Then he decided that he knew what they would found, and just sedated me. The "just sedate, antidepressants when needed" thing lasted for a long time before I gave in to long-term antidepressant use (unfortunately by then I was developing mania).
That psychiatrist wasn't the best, nor were the next couple, and there was a good long period when I was treated by family doctors for depression. I think ambien was considered so mild that nobody worried much.
I know that paragraph wasn't in the paperwork back then. I thought the kind of insomnia I had was normal enough; it had lasted my whole life after all.
I wonder if that would have changed anything for me.