Doxepin
In 2016 the American College of Physicians advised that insomnia be treated first by treating comorbid conditions, then with cognitive behavioral therapy and behavioral changes, and then with drugs; doxepin was among those recommended for short-term help maintaining sleep, on the basis of weak evidence. The 2017 American Academy of Sleep Medicine recommendations focused on treatment with drugs were similar. A 2015 AHRQ review of treatments for insomnia had similar findings.
Idiopathic hypersomnia
Currently, there is no cure for idiopathic hypersomnia. Also, because the underlying disease mechanism is not yet fully understood (see Causes), treatment efforts have usually focused on symptom management. Although there are several FDA-approved medications for use in narcolepsy, there are no FDA-approved medicines for idiopathic hypersomnia. Therefore, the wake-promoting medications used in narcolepsy are also commonly used off-label to help manage the excessive daytime sleepiness of idiopathic hypersomnia. "These treatments have not been studied to nearly the same extent in patients with idiopathic hypersomnia, and some patients with idiopathic hypersomnia do not achieve adequate control of symptoms with these medications."