Hypnotic self administration and dose escalation

Ethanol as a Hypnotic in Insomniacs Self Administration and Effects on Sleep and Mood

“…Given the option to self administer a previously sampled color-coded capsule or no capsule before sleep (a single-choice methodology), insomniacs self administered capsules on about 70% of nights and self administered placebo as frequently as triazolam 0.25 mg (Roehrs et al 1992;Roehrs et al 1997;Roehrs et al 1996). In one of the studies the option of administering multiple capsules (a total of three) nightly was given, again in a singlechoice methodology and insomniacs administered an average triazolam dose of 0.27 mg, but double the number of placebo capsules (Roehrs et al 1996). When forced to chose between triazolam and placebo on a given night (i.e., a forced-choice methodology), insomniacs prefer active drug (Roehrs et al 1997).…”

Insomnia Pharmacotherapy

“…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]. On the other hand, in both the short-term and long-term studies those insomniacs in the placebo groups did increase their placebo "dose" [45,48]. In other words an ineffective hypnotic (i.e., placebo) is dose escalated.…”

“…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].…”

Nighttime versus daytime hypnotic self-administration

“…Nighttime studies of the self-administration of benzodiazepines with an indication for insomnia similarly have found that healthy normals do not self-administer benzodiazepines before sleep (Roehrs et al 1992(Roehrs et al , 1996(Roehrs et al , 1997(Roehrs et al , 2001a. However, patients with insomnia selfadministered capsules before sleep on approximately 70% of nights, with placebo and triazolam being selfadministered equally as often (Roehrs et al 1992(Roehrs et al , 1996(Roehrs et al , 1997.…”

“…However, patients with insomnia selfadministered capsules before sleep on approximately 70% of nights, with placebo and triazolam being selfadministered equally as often (Roehrs et al 1992(Roehrs et al , 1996(Roehrs et al , 1997. When forced to choose between placebo and triazolam, the insomniacs preferred triazolam (Roehrs et al 1997); when self-administering before sleep at home, the nightly rate was lower than that in the laboratory, about 50% (Roehrs et al 2001b); when multiple doses were available, the nightly dose self-administered was a therapeutic dose which was not increased over the short-term (Roehrs et al 1996); and finally, when rebound insomnia occurred during drug discontinuation, the likelihood of subsequent self-administration was not enhanced (Roehrs et al 1992).…”