Sleep and Biological Rhythms

, Volume 17, Issue 1, pp 63–72 | Cite as

Development and psychometric evaluation of the Hypnotic-Use Urge Scale

  • Chun-Hui Jen
  • Chien-Ming YangEmail author
  • Chang-Wei Chen
  • Hsiu-Ting Yu
  • Yu-Shuan Lai
  • Hsin-Chien Lee
  • Jia-Ying Sung
Original Article


Hypnotic dependence is a major concern for long-term hypnotic use, but is not consistently reported in empirical studies. The inconsistent findings may be in part due to individual differences in the psychological processes of hypnotic use. To further the understanding of this issue, the current study developed the Hypnotic-Use Urge Scale (HUS) to measure the urge to take hypnotics at bedtime. Insomnia patients with a history of hypnotic use (n = 202; mean age = 46.4 years) were included in the study. Participant’s agreement with 37 statements regarding anticipation, desire, and feelings about hypnotic use at bedtime was rated using Likert-type scales. An exploratory factor analysis identified 20 statements to be included as items of the HUS, which were categorized into three subscales: Factor 1—anticipated effects of hypnotic use; Factor 2—compelling desire to use hypnotics; and Factor 3—preoccupation and pleasurable feelings from hypnotic use. The total scale and subscales demonstrated good internal consistency and test–retest reliability. The scale scores correlated significantly with the frequency of hypnotic use. Intriguingly, although Factor 1 accounted for the highest portion of the total variance, Factor 2 was identified to be the best predictor for the frequency of hypnotic use. The results support the use of the HUS as a valid and reliable measure to assess the urge to use hypnotic at bedtime. It could be used to measure the psychological processes associated with hypnotic dependence in both research and clinical settings.


Hypnotic Urge Rating Scale Reliability Validity 



This study was supported by the National Science Council, Taiwan (NSC101-2410-H-004-082-MY3).

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This study has been approved by the TMU-Joint Institutional Review Board (Permission number: 201205052).


  1. 1.
    Morin CM, LeBlanc M, Daley M, Gregoire J, Merette C. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med. 2006;7:123–30.CrossRefGoogle Scholar
  2. 2.
    Kripke DF. Chronic hypnotic use: deadly risks, doubtful benefit. Sleep Med Rev. 2000;4:5–20.CrossRefGoogle Scholar
  3. 3.
    National Institutes of Health. National Institutes of Health state-of-the-science conference statement: manifestations and management of chronic insomnia in adults, June 13–15, 2005. Sleep. 2005;28:1049–1057.CrossRefGoogle Scholar
  4. 4.
    Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4:487–504.Google Scholar
  5. 5.
    Riemann D, Perlis ML. The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Med Rev. 2009;13:205–14.CrossRefGoogle Scholar
  6. 6.
    Ohayon M. Epidemiological study on insomnia in the general population. Sleep. 1996;19(3 Suppl):7–15.CrossRefGoogle Scholar
  7. 7.
    Omvik S, Pallesen S, Bjorvatn B, Sivertsen B, Havik OE, Nordhus IH. Patient characteristics and predictors of sleep medication use. Int Clin Psychopharmacol. 2010;25:91–100.CrossRefGoogle Scholar
  8. 8.
    Golombok S, Moodley P, Lader M. Cognitive impairment in long-term benzodiazepine users. Psychol Med. 1988;18:365–74.CrossRefGoogle Scholar
  9. 9.
    Holbrook AM, Crowther R, Lotter A, Cheng C, King D. Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ. 2000;162:225–33.Google Scholar
  10. 10.
    Mendelson WB, Roth T, Cassella J, Roehrs T, Walsh JK, Woods JH, et al. The treatment of chronic insomnia: drug indications, chronic use and abuse liability. Summary of a 2001 new clinical drug evaluation unit meeting symposium. Sleep Med Rev. 2004;8:7–17.CrossRefGoogle Scholar
  11. 11.
    Lucki I, Rickels K, Geller AM. Chronic use of benzodiazepines and psychomotor and cognitive test performance. Psychopharmacology (Berl). 1986;88:426–433.CrossRefGoogle Scholar
  12. 12.
    McAndrews MP, Kayumov L, Phillipson R, Shapiro CM. Self-report of memory and affective dysfunction in association with medication use in a sample of individuals with chronic sleep disturbance. Hum Psychopharmacol. 2000;15:583–7.CrossRefGoogle Scholar
  13. 13.
    McAndrews MP, Weiss RT, Sandor P, Taylor A, Carlen PL, Shapiro CM. Cognitive effects of long-term benzodiazepine use in older adults. Hum Psychopharmacol. 2003;18:51–7.CrossRefGoogle Scholar
  14. 14.
    Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, et al. The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs. J Gen Intern Med. 2007;22:1335–50.CrossRefGoogle Scholar
  15. 15.
    Walsh JK. Pharmacologic management of insomnia. J Clin Psychiatry. 2003;65:41–5.Google Scholar
  16. 16.
    Drover DR. Comparative pharmacokinetics and pharmacodynamics of short-acting hypnosedatives. Clin Pharmacokinet. 2004;43:227–38.CrossRefGoogle Scholar
  17. 17.
    Zammit G. Comparative tolerability of newer agents for insomnia. Drug Saf. 2009;32:735–48.CrossRefGoogle Scholar
  18. 18.
    Cimolai N. Zopiclone: is it a pharmacologic agent for abuse? Can Fam Physician. 2007;53:2124–9.Google Scholar
  19. 19.
    Liappas I, Malitas P, Dimopoulos N, Gitsa O, Liappas A, Nikolaou CK, Christodoulou G. Zolpidem dependence case series: possible neurobiological mechanisms and clinical management. J Psychopharmacol. 2003;17:131–5.CrossRefGoogle Scholar
  20. 20.
    Victorri-Vigneau C, Dailly E, Veyrac G, Jolliet P. Evidence of zolpidem abuse and dependence: results of the French Centre for Evaluation and Information on Pharmacodependence (CEIP) network survey. Br J Clin Pharmacol. 2007;64:198–209.CrossRefGoogle Scholar
  21. 21.
    Busto U, Pain T, Lanctôt K, Einarson T, Naranjo C. Assessment of the risk of therapeutic dose benzodiazepine withdrawal reactions using meta-analysis. Can J Clin Pharmacol. 1998;5:161–8.Google Scholar
  22. 22.
    Curran H, Collins R, Fletcher S, Kee S, Woods B, Iliffe S. Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life. Psychol Med. 2003;33:1223–37.CrossRefGoogle Scholar
  23. 23.
    Gillin JC, Spinweber CL, Johnson LC. Rebound insomnia: a critical review. J Clin Psychopharmacol. 1989;9:161–72.CrossRefGoogle Scholar
  24. 24.
    Roehrs T, Zorick F, Wittig R, Roth T. Dose determinants of rebound insomnia. Br J Clin Pharmacol. 1986;22:143–7.CrossRefGoogle Scholar
  25. 25.
    Oswald I, French C, Adam K, Gilham J. Benzodiazepine hypnotics remain effective for 24 weeks. Br Med J (Clin Res Ed). 1982;284:860–3.CrossRefGoogle Scholar
  26. 26.
    Allen RP, Mendels J, Nevins DB, Chernik DA, Hoddes E. Efficacy without tolerance or rebound insomnia for midazolam and temazepam after use for one to three months. J Clin Pharmacol. 1987;27:768–75.CrossRefGoogle Scholar
  27. 27.
    Walsh JK, Krystal AD, Amato DA, Rubens R, Caron J, Wessel TC, et al. Nightly treatment of primary insomnia with eszopiclone for six months: effect on sleep, quality of life, and work limitations. Sleep. 2007;30:959–68.CrossRefGoogle Scholar
  28. 28.
    Roth T, Walsh JK, Krystal A, Wessel T, Roehrs TA. An evaluation of the efficacy and safety of eszopiclone over 12 months in patients with chronic primary insomnia. Sleep Med. 2005;6:487–95.CrossRefGoogle Scholar
  29. 29.
    Pakes GE, Brogden RN, Heel RC, Speight TM, Avery GS. Triazolam: a review of its pharmacological properties and therapeutic efficacy in patients with insomnia. Drugs. 1981;22:81–110.CrossRefGoogle Scholar
  30. 30.
    Maarek L, Cramer P, Attali P, Coquelin JP, Morselli PL. The safety and efficacy of zolpidem in insomniac patients: a long-term open study in general practice. J Int Med Res. 1992;20:162–70.CrossRefGoogle Scholar
  31. 31.
    Schenck CH, Mahowald MW. Long-term, nightly benzodiazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep in 170 adults. Am J Med. 1996;100:333–7.CrossRefGoogle Scholar
  32. 32.
    Krystal AD, Walsh JK, Laska E, Caron J, Amato DA, Wessel TC, Roth T. Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. Sleep. 2003;26:793–9.CrossRefGoogle Scholar
  33. 33.
    Jacobs GD. Is eszopiclone appropriate and effective for the long-term clinical management of insomnia. Sleep. 2004;27:345.CrossRefGoogle Scholar
  34. 34.
    Tsai YL, Chen CW, Yang CM, Lin YS. Qualitative study of long-term sedative-hypnotic use patterns. J Sleep Disord Treat Care. 2016. Scholar
  35. 35.
    Cheung JM, Bartlett DJ, Armour CL, Laba TL, Saini B. To drug or not to drug: a qualitative study of patients’ decision-making processes for managing insomnia. Behav Sleep Med. 2016;18:1–26.CrossRefGoogle Scholar
  36. 36.
    O’Connor KP, Marchand A, Bélanger L, Mainguy N, Landry P, Savard P, et al. Psychological distress and adaptational problems associated with benzodiazepine withdrawal and outcome: a replication. Addict Behav. 2004;29:583–93.CrossRefGoogle Scholar
  37. 37.
    Voshaar RCO, Gorgels WJ, Mol AJ, van Balkom AJ, Mulder J, van de Lisdonk EH, et al. Predictors of long-term benzodiazepine abstinence in participants of a randomized controlled benzodiazepine withdrawal program. Can J Psychiatry. 2006;51:445–52.CrossRefGoogle Scholar
  38. 38.
    Bottlender M, Soyka M. Impact of craving on alcohol relapse during, and 12 months following, outpatient treatment. Alcohol Alcohol. 2004;39:357–61.CrossRefGoogle Scholar
  39. 39.
    Killen JD, Fortmann SP. Craving is associated with smoking relapse: findings from three prospective studies. Exp Clin Psychopharmacol. 1997;5:137–42.CrossRefGoogle Scholar
  40. 40.
    Skinner MD, Aubin HJ. Craving’s place in addiction theory: contributions of the major models. Neurosci Biobehav Rev. 2010;34:606–23.CrossRefGoogle Scholar
  41. 41.
    Rosenberg H. Clinical and laboratory assessment of the subjective experience of drug craving. Clin Psychol Rev. 2009;29:519–34.CrossRefGoogle Scholar
  42. 42.
    Robinson TE, Berridge KC. The neural basis of drug craving: an incentive-sensitization theory of addiction. Brain Res Rev. 1993;18:247–91.CrossRefGoogle Scholar
  43. 43.
    Tiffany ST. Cognitive concepts of craving. Alcohol Res Health. 1999;23:215–24.Google Scholar
  44. 44.
    Redish AD, Jensen S, Johnson A. A unified framework for addiction: vulnerabilities in the decision process. Behav Brain Sci. 2008;31:415–37.Google Scholar
  45. 45.
    Tiffany ST, Drobes DJ. The development and initial validation of a questionnaire on smoking urges. Br J Addict. 1991;86:1467–76.CrossRefGoogle Scholar
  46. 46.
    Mol A, Voshaar R, Gorgels W, Breteler M, van Balkom A, van de Lisdonk E, et al. Development and psychometric evaluation of the Benzodiazepine Craving Questionnaire. Addiction. 2003;98:1143–52.CrossRefGoogle Scholar
  47. 47.
    Morin CM. Insomnia: psychological assessment and management. New York: Guilford Press; 1993.Google Scholar
  48. 48.
    Bastien C, Vallières A, Morin C. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307.CrossRefGoogle Scholar
  49. 49.
    Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22–33.Google Scholar
  50. 50.
    Lecrubier Y, Sheehan D, Weiller E, Amorim P, Bonora I, Sheehan K, et al. The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry. 1997;12:224–31.CrossRefGoogle Scholar
  51. 51.
    Sheehan D, Lecrubier Y, Sheehan K, Janavs J, Weiller E, Keskiner A, et al. The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. Eur Psychiatry. 1997;12:232–41.CrossRefGoogle Scholar
  52. 52.
    Marlatt GA. Craving notes. Addiction. 1987;82:42–4.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Sleep Research 2018

Authors and Affiliations

  1. 1.Sleep LaboratoryNational Chengchi UniversityTaipeiTaiwan
  2. 2.Department of PsychologyNational Chengchi UniversityTaipeiTaiwan
  3. 3.Research Center of Mind, Brain, and LearningNational Chengchi UniversityTaipeiTaiwan
  4. 4.Department of Psychiatry, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  5. 5.Department of Psychiatry, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
  6. 6.Department of Neurology, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
  7. 7.Department of Neurology, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan

Personalised recommendations