Conclusion
Chronic primary insomnia is a recurrent condition that negatively effects the daily functioning of patients diminishing the quality of their lives. It is associated with and in some situations is a risk factor in both psychiatric (depression) and physical illness (cardio-vascular). Treatment effectiveness in insomnia has been shown short term for both drug (benzodiazepine and benzodiazepine agonists) and behavioral treatment. Expert opinion has strongly advised against long term drug treatment because of concerns about residual sedative effects, memory impairment, falls, respiratory depression, rebound insomnia, medication abuse, dose escalation, dependency and withdrawal difficulties, and an increased risk of death possibly associated with the current hypnotic medications. Many of these concerns could be made against using these agents at all. Worries about these potential problems are challenged by the widespread clinical practice of using hypnotic drugs long term without any of these difficulties developing and with patients who feel their sleep and daily function is improved with the nightly use of their sleeping pill. The ability to mount a randomized, placebo controlled, parallel group, double blind trial of hypnotic medication in primary insomnia may not be possible. We may have to develop large systematic clinical databases, a number of case series in effect, to monitor both emergent symptoms and possible clinical effectiveness. There is the additional concern that there is a reluctance to examine the long — term drug treatment of insomnia. This reluctance may reflect a negative moral judgement about treating primary insomnia with drugs, a sort of “PharmacologicalCalvinism”, rather than just a data based judiciousness.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Salzman C. An 87-year-old woman taking a benzodiazepine. JAMA 1999; 281:1121–1125.
Portnoi VA. Should benzodiazepines in an 87-year-old woman be tapered and discontinued? JAMA 1999; 282:1128.
Salzman C. In reply: Should benzodiazepines in an 87-year-old woman taking a benzodiazepine be tapered? JAMA 1999; 282:1128.
Parker RA, Hartman EE. An 87-year-old woman taking a benzodiazepine. 1 year later. JAMA 1999; 282:1960
Tsoi WF. Insomnia: Drug treatment. Ann Acad Med Singapore 1991; 20:269–272.
Kupfer DJ, Reynolds CF. Current concepts: Management of insomnia. NEJM 1997; 336:341–346.
Kripke DF, Klauber MR, Wingard DL et al. Mortality hazard associated with prescription g a benzodiazepine be tapered and discontinued? JAMA 1999; 282:1128.
Ashton H. Guidelines for the rational use of benzodiazepines. When and what to use. Drugs 1994; 48:25–40.
Ancoli-Israel S, Roth T. Characteristics of insomnia in the united states: Results of the 1991 national sleep foundation survey. 1. Sleep 1999; 22(Suppl):S347–353.
The gallop organization. Sleep in America. Washington DC: National sleep foundation, 1995:1–78.
Mellinger GD, Balter MB, Uhlenhuth EH. Insomnia and its treatments, prevalence and correlates. Arch Gen Psychiatry 1985; 42:225–32.
Swift CG, Swift MR, Hamley J et al. Side effect ‘tolerance’ in elderly recepients of benzodiazepine hypnotics. Age Ageing 1984; 13:335–43.
Dunbar GC, Perera MH, Jenner FA. Patterns of benzodiazepine use in Great Britain as measured by a population survey. Br J Psychiatry 1989; 155:836–41.
Hohagen F, Rink K, Kappler C et al. Prevalence and treatment of insomnia in general practice. A longitudinal study. Eur Arch Psychiatry Clin Neurosci 1993; 242:329–36.
Rayon P, Serrao-Castro M, del-Barrio H et al. Hypnotic drug use in Spain: A national study based on a network of community pharmacies. Spanish group for the study of hypnotic drug utilization. Ann Pharmacother 1996; 30:1092–100.
Ohayon M. Epidemiological study of insomnia in the general population. Sleep 1996; 19(Suppl 3):S7–15.
Balter MB, Uhlenhuth EH. The beneficial and adverse effects of hypnotics. J Clin Psychiatry 1991; 52(Suppl):16–23.
Balter MB, Uhlenhuth EH. New epidemiologic findings about insomnia and its treatment. J Clin Psychiatry 1992; 53(Suppl):34–9.
Walsh J, Ustun TB. Prevalence and heath consequences of insomnia. Sleep 1999; 22(Suppl 3):S427–36.
Johnson EO. Sleep in America. Washington DC: National Sleep Foundation 1999:1–122.
Roth T, Ancoli-Israel S. Daytime consequences and correlates of insomnia in the united states: Results of the 1991 national sleep foundation survey. II Sleep 1999; 22(Suppl 2):S354–58.
Zammit GK, Weiner J, Damato N et al. Quality of life in people with insomnia. Sleep 1999; 22(Suppl 2):S379–85.
Morin CM, Culbert JP, Schwartz SM. Nonpharmacological interventions for insomnia: A metaanalysis of treatment efficacy. Am J Psychiatry 1994; 151:1172–80.
Nowell PD, Mazumdar S, Buysse DJ et al. Benzodiazepines and zolpidem for chronic insomnia: A metaanalysis of treatment efficacy. JAMA 1997; 278:2170–77.
Morin CM. Behavioral and pharmacological treatment for insomnia. In reply: Letter to the editor. JAMA 1999; 282:1130–31.
Ancoli-Israel S, Richardson GS, Mangano RM et al. Long term exposure to zaleplon is safe and effective in younger-elderly and older elderly patient with primary insomnia. Sleep (abst.) 2003; 26:A-77.
Krystal A, Walsh J, Roth T et al. The sustained efficacy and safety of eszopiclone over six months of nightly treatment: A placebo-controlled study in patients with chronic insomnia. Sleep (abst.) 2003; 26:A310.
Gillen JC, Byerley WF. The diagnosis and management of insomnia. NEJM 1990; 322:339–48.
Langer S, Mendelson W, Richardson G. Symptomatic treatment of insomnia. Sleep 1999; 22(Suppl 3):S437–45.
Kesson CM, Lawson DH, Ankier SI. Long-term efficacy and tolerability of anew hypnotic-loprazolam. Br J Clin Pract 1984; 38:306–12.
Vogel G. Clinical uses and advantages of low doses of benzodiazepine hypnotics. J Clin Psychiatry 1992; 53(Suppl):19–22.
Reynolds CF, Regestein Q, Nowell PD et al. Treatment of insomnia in the elderly. In: Salzman C, ed. Clinical Geriatric Psychopharmacology. Baltimore: Williams and Wilkens, 1998:395–416.
Shorr RI, Robin DW. Rational use of benzodiazepines in the elderly. Drugs Aging 1994; 55:192–9.
Foley DJ, Monjan AA, Izmirlian G et al. Incidence and remission of insomnia among elderly adults: An epidemiologic study of 6,800 persons over three years. Sleep 1999; 22(Suppl 2):S366–72.
Kramer M, Svinte M. Falls, hypnotics and altering physician prescribing practice. Sleep Res 1992; 21:58.
Erman M. Efficacy and safety of hypnotic medications. In: Goldberg JR, ed. The Pharmacological Management of Insomnia. Washington DC: National Sleep Foundation, 1996:23–34.
Morin CM, Colecchi G, Stone J et al. Behavioral and pharmacological therapies for late-life insomnia. JAMA 1999; 281:991–99.
Lader M. Anxiety or depression during withdrawal of hypnotic treatments. J Psychosom Res 1994; 38(Suppl 1):113–23.
Ettorre E, Klaukka T, Riska E. Psychtropic drugs: Long term use, dependency and the gender factor. Soc Sci Med 1994; 39:1667–73.
Roth T, Kramer M, Roehrs T. The consistency of sleep measures. In: Koella WP, Levin P, eds. Sleep 1976: Proceedings of the Third European Sleep Congress. New York: S. Karger, 1977:286–8.
von Delbruck O, Goetzke E, Nagel C. Tolerance studies with brotizolam in hospitalized patients. Br J Clin Pharmacol 1983; 16(Suppl 2):S385–89.
Mittler MM, Carscadon MA, Phillips RL et al. Hypnotic efficacy of temazepam: A long-term sleep laboratory evaluation. Br J Clin Pharmacol 1979; 8:S63–8.
Leibovitz M, Sunshine A. Long-term hypnotic efficacy and safety of triazolam and flurazepam. J Clin Pharmacol 1978; 18:302–9.
Oswald I, French C, Adam K et al. Benzodiazepine hypnotics remain effective for 24 weeks. Br Med J 1982; 284:860–3.
Bunney Jr WE, Azarnoff DL, Brown Jr BW et al. Report of the institute of medicine committee on the efficacy and safety of halcion. Arch Gen Psychiatry 1999; 56:349–52.
Hartellius H, Larsson AK, Lepp M et al. Acontrolled study of flunitrazepam, nitrazepam and placebo, with special regard to withdrawal effects. Acta Psychiatr Scand 1978; 58:1–15.
Kirsch I, Sapirstein G. Listening to prozac but hearing placebo: A metaanalysis of antidepressant medication. Prevention & Treatment 1998; 1:Article 0002a. Available on the World Wide Web: http://journals.apa.org/prevention/volume1/pre0010002a.html.
Klein DF. Listening to meta-analysis but hearing bias. Prevention & Treatment Amer Psychol Assoc 1998; 1:Article 0006c.
Woolf S. The need for perspective in evidence based medicine. JAMA 1999; 282:2358–65.
Regestein Q. Specific effects of sedative/hypnotic drugs in the treatment of incapacitating chronic insomnia. Am J Med 1987; 83:909–16.
Pakes GE, Brogden RN, Heel RC et al. Triazolam: A review of its pharmacological properties and therapeutic efficacy in patients with insomnia. Drugs 1981; 22:81–110.
Clark BG, Jue SG, Dawson GW et al. Lopazolam. A preliminary review of its pharmacodynamic properties and therapeutic efficacy in insomnia. Drugs 1986; 31:500–16.
Maarek L, Cramer P, Attali P et al. 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.
Schenck CH, Mahwold 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.
Kramer M, Bailey S, Sepate M et al. The effectiveness of sleeping medication in chronic insomnia: A clinical case series. Sleep Res 1993; 22:219.
Regestein QR, Reich P. Asleep clinic within a general hospital psychiatry services. Gen Hosp Psychiatry 1980; 2:112–17.
Walsh J, Engelhardt C. Trends in the pharmacological treatment of insomnia. J Clin Psychiatry 1995; 53(12 Suppl):10–7.
Kramer M, Bailey S, Sepate M. Longterm medicinal treatment of insomnia: A follow up study. Sleep Res 1995; 24:266.
Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders: An opportunity for prevention. JAMA 1989; 262:1479–84.
Kramer M, Dashevsky B, Bailey S et al. Behavioral treatment of insomnia: A follow up study. Sleep Res 1996; 25:271.
Dashevsky B, Kramer M. Behavioral treatment of chronic insomnia in psychiatrically ill patients. J Clin Psychiatry 1998; 59:693–9.
Silberman EK. Psychiatrists and internists beliefs about benzodiazepines. Primary Psychology 1998; 5:1–8.
Zwar NA, Gordon JJ, Sanson-Fisher RW. Antibiotic and benzodiazepine prescribing by general practice trainees. Med J Aust 1994; 161:491–3.
Yeo GT, deBurgh SP, Letton T et al. Educational visiting and hypnosedative prescribing in general practice. Fam Pract 1994; 11:57–61.
Dunner DL. Commentary: Long-term use of sedative and hypnotic medication. Arch Gen Psyychiatry 1999; 56:355.
Mendelson WB. Long term follow-up of chronic insomnia. Sleep 1995; 18:698–701.
Kripke DF. Chronic hypnotic use: Deadly risks, doubtful benefit. Sleep Medicine Reviews 2000; 4:5–20.
Reynolds CF, Buysee DJ, Kupfer DJ. Treating insomnia in older adults: Taking a long term view. JAMA 1999; 281:1034–1035.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2006 Landes Bioscience/Eurekah.com and Springer Science+Business Media
About this chapter
Cite this chapter
Kramer, M. (2006). Long-Term Use of Sleeping Pills in Chronic Insomnia. In: Sleep and Sleep Disorders. Springer, Boston, MA. https://doi.org/10.1007/0-387-27682-3_14
Download citation
DOI: https://doi.org/10.1007/0-387-27682-3_14
Publisher Name: Springer, Boston, MA
Print ISBN: 978-0-387-27681-6
Online ISBN: 978-0-387-27682-3
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)