An approach to long-term sedative-hypnotic use

Shahid, Azmeh; Chung, Sharon A.; Phillipson, Ron; Shapiro, Colin M.

doi:10.2147/nss.s28362

Cited by 10 publications

(5 citation statements)

References 75 publications

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“…Finally, given the increasing charge to mitigate MCI and AD development, our findings provide opportunities for researchers, clinicians, and patients to engage in discussions about the effectiveness of sleep medications. For instance, while trazodone and zolpidem can positively impact sleep disturbance in individuals with normal cognition [45,93,100], additional research is needed to support these findings in the context of MCI mitigation among individuals over the age of 65.…”

Section: Discussionmentioning

confidence: 99%

Mild cognitive impairment: associations with sleep disturbance, apolipoprotein e4, and sleep medications

Burke

Spadola

et al. 2018

Sleep Medicine

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Objective: Mild cognitive impairment (MCI) is associated with increased memory problems although the ability to complete daily life activities remains relatively intact. This study examined: (1) if sleep disturbance increased the hazard of MCI; (2) if APOE e4 carriers with sleep disturbance experience an increased risk of MCI; and, (3) if prescription sleep medications provide a protective effect against MCI. We hypothesized that sleep disturbance increases the hazard of MCI, this relationship is stronger among APOE e4 carriers reporting a sleep disturbance. Furthermore, we hypothesized that sleep medications decrease the hazard of MCI. Methods: To determine whether sleep medication mediates the risk of developing MCI for individuals with sleep disturbance and/or APOE e4, we analyzed the National Alzheimer’s Coordinating Center Uniform Data Set. We selected participants with normal cognition at baseline (n = 6798), and conduced survival analyses. Results: Our main findings indicated that the hazard of MCI was significantly associated with sleep disturbance. The hazard remained among those who did not use sleep medication. Trazodone and zolpidem users did not have a significant hazard of MCI, but the significant hazard remained for those who did not use these medications. APOE e4 carriers had a significantly higher hazard of MCI. Among e4 carriers who used trazodone or zolpidem, there was not a statistically significant risk of MCI. Conclusion: This study demonstrated the potential utilization of trazodone and zolpidem in the treatment of sleep disturbance while potentially mitigating the risk of MCI. While trazodone and zolpidem have been shown to positively impact sleep disturbance in individuals with normal cognition, further research should explore these findings given that these medications are potentially inappropriate for older adults.

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Section: Discussionmentioning

confidence: 99%

Mild cognitive impairment: associations with sleep disturbance, apolipoprotein e4, and sleep medications

Burke

Spadola

et al. 2018

Sleep Medicine

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“…Symptomatic treatment of ID with hypnotics is currently discouraged because of the risk of dependency and possible daytime consequences. There are however valid arguments against the conviction that long-term hypnotic treatment is to be strictly avoided (346). Also the current first-line treatment, cognitive behavior therapy for insomnia (CBTI), does not bring sufficient relief for many (161).…”

Section: Table Of Contentsmentioning

confidence: 99%

Brain mechanisms of insomnia: new perspectives on causes and consequences

Someren

2021

Physiological Reviews

286

179

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While insomnia is the second most common mental disorder, progress in our understanding of underlying neurobiological mechanisms has been limited. The present review addresses the definition and prevalence of insomnia and explores its subjective and objective characteristics across the 24-hour day. Subsequently, the review extensively addresses how the vulnerability to develop insomnia is affected by gene variants, early life stress and major life events and brain structure and function. Further supported by the clear mental health risks conveyed by insomnia, the integrated findings suggest that the vulnerability to develop insomnia could rather be found in brain circuits regulating emotion and arousal than in circuits involved in circadian and homeostatic sleep regulation. Finally, a testable model is presented. The model proposes that in people with a vulnerability to develop insomnia, the locus coeruleus is more sensitive to - or receives more input from - the salience network and related circuits, even during REM sleep, when it should normally be sound asleep. This vulnerability may ignite a downwards spiral of insufficient overnight adaptation to distress, resulting in accumulating hyperarousal which in turn impedes restful sleep and moreover increases the risk of other mental health adversity. Sensitized brain circuits are likely to be subjectively experienced as "sleeping with one eye open". The proposed model opens up the possibility for novel intervention studies and animal studies, thus accelerating the ignition of a neuroscience of insomnia, which is direly needed for better treatment.

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“…5 The chronic nature of insomnia implies the potential for long-term drug therapy, particularly with sedative hypnotics, a controversial topic beyond the scope of this article. 6 Insomnia is frequently associated with psychiatric disorders. Estimates report that as many as 40% of patients with insomnia have a Purpose.…”

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confidence: 99%

Quetiapine for insomnia: A review of the literature

Anderson

Griend

2014

American Journal of Health-System Pharmacy

107

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Robust studies evaluating the safety and efficacy of quetiapine for the treatment of insomnia are lacking. Given its limited efficacy data, its adverse-effect profile, and the availability of agents approved by the Food and Drug Administration for the treatment of insomnia, quetiapine's benefit in the treatment of insomnia has not been proven to outweigh potential risks, even in patients with a comorbid labeled indication for quetiapine.

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An approach to long-term sedative-hypnotic use

Cited by 10 publications

References 75 publications

Mild cognitive impairment: associations with sleep disturbance, apolipoprotein e4, and sleep medications

Mild cognitive impairment: associations with sleep disturbance, apolipoprotein e4, and sleep medications

Brain mechanisms of insomnia: new perspectives on causes and consequences

Quetiapine for insomnia: A review of the literature

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