Benzodiazepines and Zolpidem for Chronic Insomnia

Nowell, Peter D.; Mazumdar, Sati; Buysse, Daniel J.; Dew, Mary Amanda; Reynolds, Charles F.; Kupfer, David J.

doi:10.1001/jama.1997.03550240060035

Cited by 371 publications

(46 citation statements)

References 57 publications

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“…For people with insomnia, the most common treatments used are over-the-counter antihistamines, alcohol, and prescription medications such as benzodiazepine receptor agonists 45. These prescription hypnotics have been shown to have good short-term efficacy46 and good durability over time frames of up to 12 months,47,48 but clinical outcomes do not persist after treatment discontinuation, and issues such as rebound insomnia, dependence, abuse potential and respiratory depression49,50 make providers and patients hesitant to use them. Cognitive behavioral therapy for insomnia is effective,51 but it is initially time-intensive and costly, and not all patients are willing or able to engage in this form of psychotherapy.…”

Section: Discussionmentioning

confidence: 99%

What puts heart failure patients at risk for poor medication adherence?

Knafl¹,

Riegel²

2014

PPA

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BackgroundMedication nonadherence is a major cause of hospitalization in patients with heart failure (HF), which contributes enormously to health care costs. We previously found, using the World Health Organization adherence dimensions, that condition and patient level factors predicted nonadherence in HF. In this study, we assessed a wider variety of condition and patient factors and interactions to improve our ability to identify those at risk for hospitalization.Materials and methodsMedication adherence was measured electronically over the course of 6 months, using the Medication Event Monitoring System (MEMS). A total of 242 HF patients completed the study, and usable MEMS data were available for 218 (90.1%). Participants were primarily white (68.3%), male (64.2%), and retired (44.5%). Education ranged from 8–29 years (mean, 14.0 years; standard deviation, 2.9 years). Ages ranged from 30–89 years (mean, 62.8 years; standard deviation, 11.6 years). Analyses used adaptive methods based on heuristic searches controlled by cross-validation scores. First, individual patient adherence patterns over time were used to categorize patients in poor versus better adherence types. Then, risk factors for poor adherence were identified. Finally, an effective model for predicting poor adherence was identified based on identified risk factors and possible pairwise interactions between them.ResultsA total of 63 (28.9%) patients had poor adherence. Three interaction risk factors for poor adherence were identified: a higher number of comorbid conditions with a higher total number of daily medicines, older age with poorer global sleep quality, and fewer months since diagnosis of HF with poorer global sleep quality. Patients had between zero and three risk factors. The odds for poor adherence increased by 2.6 times with a unit increase in the number of risk factors (odds ratio, 2.62; 95% confidence interval, 1.78–3.86; P<0.001).ConclusionNewly diagnosed, older HF patients with comorbid conditions, polypharmacy, and poor sleep are at risk for poor medication adherence. Interventions addressing these specific barriers are needed.

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Section: Discussionmentioning

confidence: 99%

What puts heart failure patients at risk for poor medication adherence?

Knafl¹,

Riegel²

2014

PPA

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“…Prescription medication treatment has good short term efficacy (Nowell et al, 1997), however the untoward side effects (e.g., dependence, rebound insomnia, cognitive impairment, and fall risk in older adults) often outweigh the clinical benefit (Roth, Walsh, Krystal, Wessel, & Roehrs, 2005). CBT-I is widely considered the gold standard intervention for insomnia, with treatment effects comparable to or exceeding, those observed for medications (Jungquist et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Open-Loop Neurofeedback Audiovisual Stimulation: A Pilot Study of Its Potential for Sleep Induction in Older Adults

Tang

Vitiello

Perlis

et al. 2015

Appl Psychophysiol Biofeedback

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“…Adding to this complexity, there continues to be considerable controversy over the meaning of the discrepancies that sometimes exist between subjective and objective (polysomnographic) measures of good and bad sleep [59]. Thus, attention has been focused either on the development of more potent melatonin analogs with prolonged effects or on the design of prolonged-release melatonin preparations [60,61].…”

Section: Treatment Of Menopausal Insomnia Using Melatoninmentioning

confidence: 99%

Contraceptive Method Mix Utilization and its Associated Factors among Married Women in Gedeo Zone, Southern Nations, Nationality and People Region-Ethiopia: A Community based Cross Sectional Study

Jehan

Masters-Isarilov

Salifu

et al. 2015

Epidemiology (Sunnyvale)

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One of the core symptoms of the menopausal transition is sleep disturbance. Peri-menopausal women often complain of difficulties initiating and/or maintaining sleep with frequent nocturnal and early morning awakenings. Factors that may play a role in this type of insomnia include vasomotor symptoms, changing reproductive hormone levels, circadian rhythm abnormalities, mood disorders, coexistent medical conditions, and lifestyle. Other common sleep problems in this age group, such as obstructive sleep apnea and restless leg syndrome, can also worsen the sleep quality. Exogenous melatonin use reportedly induces drowsiness and sleep and may ameliorate sleep disturbances, including the nocturnal awakenings associated with old age and the menopausal transition. Recently, more potent melatonin analogs (selective melatonin-1 (MT1) and melatonin-2 (MT2) receptor agonists) with prolonged effects and slow-release melatonin preparations have been developed. They were found effective in increasing total sleep time and sleep efficiency as well as in reducing sleep latency in insomnia patients. The purpose of this review is to give an overview on the changes in hormonal status to sleep problems among menopausal and postmenopausal women.

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Benzodiazepines and Zolpidem for Chronic Insomnia

Cited by 371 publications

References 57 publications

What puts heart failure patients at risk for poor medication adherence?

What puts heart failure patients at risk for poor medication adherence?

Open-Loop Neurofeedback Audiovisual Stimulation: A Pilot Study of Its Potential for Sleep Induction in Older Adults

Contraceptive Method Mix Utilization and its Associated Factors among Married Women in Gedeo Zone, Southern Nations, Nationality and People Region-Ethiopia: A Community based Cross Sectional Study

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