Disturbed sleep predicts hypnotic self-administration

Roehrs, Timothy; Bonahoom, Alicia; Pedrosi, Bonita; Rosenthal, León; Roth, Thomas

doi:10.1016/s1389-9457(01)00125-3

Cited by 25 publications

(14 citation statements)

References 9 publications

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“…A substantial proportion of patients use prescribed medication for longer periods [38] . PSG evaluations have been useful in determining sleep variables predictive of the self-administration of sleep medications [42] . Evaluations of patient self-administration indicate that patterns of hypnotic use reflect a desire for symptom relief rather than drug craving [39] .…”

Section: Objective Measures Of Sleepmentioning

confidence: 99%

Objective and subjective measures for sleep disorders

Zhang

Zhi-gang

2007

Neurosci. Bull.

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Subjective and objective measures of sleep structure or quality could help to characterize the chronic sleep disturbances, with relation to patients' risk factor profiles and co-morbidities. Studies have shown that discrepancies can occur between subjective data regarding sleep disturbances and the impact of insomnia and objective assays, and surrogate markers of sleep and sleep disturbances. Both objective and subjective measures should be incorporated into clinic studies. It seems likely that sleep quality is represented by a combination of more than one subjective sleep parameter. Objective and subjective assessments of sleep quality may relate to different parameters. Future studies incorporated both subjective and objective measures could help to address the sleep disorders.

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Section: Objective Measures Of Sleepmentioning

confidence: 99%

Objective and subjective measures for sleep disorders

Zhang

Zhi-gang

2007

Neurosci. Bull.

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“…[30][31][32] This high estimated rate of off-label MOTN use is perhaps expectable in light of broader evidence that insomniacs frequently use alcohol, over-the-counter medications, and a variety of prescription medications other than hypnotics to selfmedicate their sleep problems, 33 along with evidence that sleep maintenance insomniacs are particularly prone to self-medication. 34 We found that only a small proportion of once-per-night MOTN users (14.0%) reported that their MOTN use was on the advice of a physician, although this physician advice was reported by patients to be much more common among onceper-night MOTN users treated by a sleep medicine specialist or psychiatrist than by other practitioners. Being mindful that this result is based on patient self-report, it is possible that specialists in sleep medicine and psychiatry are more sophisticated than other practitioners regarding sleep psychopharmacology, more familiar with newer short-acting hypnotic agents, and more comfortable prescribing them for MOTN use.…”

Section: Discussionmentioning

confidence: 69%

“…This might be a chance finding in the many comparisons made here, or suggest either an especially high rate of habituation among chronic maintenance insomniacs or a lower severity threshold for selfmedication among MOTN users than other hypnotic users, perhaps due to the intermittent character of symptoms. Evidence consistent with the possibility of lower symptom tolerance has been reported in a study of predictors of sham self-medication, 34 but future research is needed to determine the extent to which this accounts for the association of MOTN use with low DMS frequency. Future research is also needed to examine other predictors of off-label MOTN use, such as the presence and severity of comorbid physical and mental disorders.…”

Section: Discussionmentioning

confidence: 71%

Middle-of-the-Night Hypnotic Use in a Large National Health Plan

Roth

Berglund²,

Shahly³

et al. 2013

Journal of Clinical Sleep Medicine

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that are approved for nocturnal awakenings and/or prolonged wake time after nocturnal awakenings, all but one stipulate bedtime administration with middle-of-the-night use being explicitly disapproved to minimize risk of residual sedation. In other words, such bedtime hypnotics are designed to be preventative treatments for possible nocturnal awakenings rather than active treatments administered after nocturnal awakenings occur. The single hypnotic accepted by the FDA for as-needed MOTN Study Objectives: Although diffi culty maintaining sleep (DMS) is the most common nighttime insomnia symptom among US adults, many FDA-approved hypnotics have indications only for sleep onset, stipulating bedtime administration to offset residual sedation. Given the well-known self-medication tendencies of insomniacs, concern arises that maintenance insomniacs might be prone to self-administer their prescribed hypnotics middle-of-the-night (MOTN) after nocturnal awakenings, despite little effi cacy-safety data supporting such use. However, no US data characterize the actual population prevalence or correlates of MOTN hypnotic use. Methods: Telephone interviews assessed patterns of prescription hypnotic use in a national sample of 1,927 commercial health plan members (ages 18-64) receiving prescription hypnotics within 12 months of study. The Brief Insomnia Questionnaire assessed insomnia symptoms. Results: 20.2% of respondents reported MOTN hypnotic use, including 9.0% who sometimes used twice-per-night (once at bedtime plus once MOTN) and another 11.2% who sometimes used MOTN, but never twice-per-night. The remaining 79.8% used exclusively at bedtime. Among exclusive MOTN users, only 14.0% used MOTN on the advice of their physician (52.6% of those seen by sleep medicine specialists and 42.6% by psychiatrists vs. 5.2% to 13.6% seen by other physicians). MOTN use predictors included DMS being the most bothersome sleep problem, long duration of hypnotic use, and low frequency of DMS. Conclusions: One-fi fth of patients with prescription hypnotics used MOTN, only a minority on advice from their physicians. Since signifi cant next-day cognitive and psychomotor impairment is documented with off-label MOTN hypnotic use, prescribing physicians should question patients about unsupervised MOTN dosing. Keywords: Insomnia, sleep maintenance, hypnotics, middleof-the-night, dosing, medication adherence, prevalence Citation: Roth T; Berglund P; Shahly V; Shillington AC; Stephenson JJ; Kessler RC. Middle-of-the-night hypnotic use in a large national health plan. J Clin Sleep Med 2013;9(7):661-668.http://dx.doi.org/10.5664/jcsm.2832 S C I E N T I F I C I N V E S T I G A T I O N SI nsomnia is the most common nighttime sleep problem, and sleep maintenance insomnia the most common insomnia symptom both in the general population 1 and among adults with clinical insomnia. 2 An estimated one-fourth of all noninstitutionalized US civilians and two-thirds of US insomniacs report frequent sleep maintenance problems involving nocturnal awakenings and/or p...

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“…Hypnotic self-administration by insomniacs is not associated with dose-escalation when provided an opportunity to self-administer multiple capsules nightly [45], it does not increase with rebound insomnia [36], it does not generalize to daytime use [46], and it varies as a function of the nature and severity of the patient's sleep disturbance [47]. To our knowledge, the only prospective study directly testing behavioral dependence during long-term use (i.e., 12 months) found no evidence of dose escalation in tri-monthly assessments during the 12 months of nightly use [48].…”

Section: Abuse Liabilitymentioning

confidence: 99%

Insomnia Pharmacotherapy

2012

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Summary The benzodiazepine receptor agonists (BzRAs) a melatonin receptor agonist and a histamine antagonist have all been approved as hypnotics. Beyond their differing mechanisms of action, they have differences in pharmacokinetics, and among the BzRAs differences in receptor subtype affinity and formulations, which provides the physician with broad options for tailoring therapy to each patient's specific needs. Consistent with their specific pharmacokinetics and formulations, these Food and Drug Administration-approved hypnotics have been shown to improve sleep with no evidence of tolerance development in long-term use. In addition, emerging data indicate these drugs also improve aspects of daytime function. Their side effects are either associated with the direct sedating effects of the drugs, doses greater than clinical doses, or a combination with alcohol or other sedating drugs. Anxiolytic BzRAs, sedating antidepressants and antipsychotics have been used off-label as hypnotics. However, in the absence of information regarding their dose range for efficacy and safety, their use as hypnotics is ill-advised.

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Disturbed sleep predicts hypnotic self-administration

Cited by 25 publications

References 9 publications

Objective and subjective measures for sleep disorders

Objective and subjective measures for sleep disorders

Middle-of-the-Night Hypnotic Use in a Large National Health Plan

Insomnia Pharmacotherapy

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