Hypnotics cause insomnia: evidence from clinical trials

Kripke, Daniel F.

doi:10.1016/j.sleep.2014.08.001

Cited by 8 publications

(11 citation statements)

References 4 publications

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“…Note also that the evidence does not permit us to assume that causality between insomnia, depression, and hypnotic usage is one-way when contemplating confounder control, as there is reverse causality 23, 24 .…”

Section: Risks Of Hypnotic Drugsmentioning

confidence: 99%

“…Most of the benzodiazepine agonist hypnotics and even suvorexant are controlled like addicting drugs by the U.S. Drug Enforcement Agency (DEA). Withdrawal from benzodiazepine agonists can cause insomnia, anxiety, agitation, confusion, and panic and even more severe somatic symptoms such as seizures and death in extreme cases 24, 72, 121, 122 . In addition, some of the short-acting sedatives such as triazolam and zolpidem may sometimes cause anxiety or agitation during the day following administration before the previous bedtime.…”

Section: Hypnotics Cause Withdrawal Insomnia Anxiety Panic and Epimentioning

confidence: 99%

“…Dr. Kripke has seen two patients taking triazolam who developed daytime panic attacks that remitted upon triazolam withdrawal and recurred upon re-challenge. There is also evidence that prolonged use of hypnotics may lead to lasting insomnia, as a consequence causing patients who withdrew from hypnotics to sleep worse than patients who had been randomized in parallel clinical trials to placeboes 24 . How long this withdrawal insomnia might persist has never been adequately defined.…”

Section: Hypnotics Cause Withdrawal Insomnia Anxiety Panic and Epimentioning

confidence: 99%

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Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Kripke

2016

F1000Res

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This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). This review includes new information on the growing USA overdose epidemic, eight new epidemiologic studies of hypnotics’ mortality not available for previous compilations, and new emphasis on risks of short-term hypnotic prescription. The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. The short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics are usually prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders might offer safer and more effective alternative approaches to insomnia.

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Section: Risks Of Hypnotic Drugsmentioning

confidence: 99%

Section: Hypnotics Cause Withdrawal Insomnia Anxiety Panic and Epimentioning

confidence: 99%

Section: Hypnotics Cause Withdrawal Insomnia Anxiety Panic and Epimentioning

confidence: 99%

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Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Kripke

2016

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“…4.6. What is often not recognized is that hypnotics cause comorbidities such as insomnia, depression, infection, gastric regurgitation, and even perhaps cancer, as proven by industry-sponsored randomized controlled clinical trials [22][23][24][25][26]. Also, controlled trials prove that many hypnotics impair next-day driving performance.…”

Section: Over-adjustment Of Confoundersmentioning

confidence: 99%

Mortality Risk of Hypnotics: Strengths and Limits of Evidence

Kripke

2015

Drug Saf

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Sleeping pills, more formally defined as hypnotics, are sedatives used to induce and maintain sleep. In a review of publications for the past 30 years, descriptive epidemiologic studies were identified that examined the mortality risk of hypnotics and related sedative-anxiolytics. Of the 34 studies estimating risk ratios, odds ratios, or hazard ratios, excess mortality associated with hypnotics was significant (p \ 0.05) in 24 studies including all 14 of the largest, contrasted with no studies at all suggesting that hypnotics ever prolong life. The studies had many limitations: possibly tending to overestimate risk, such as possible confounding by indication with other risk factors; confusing hypnotics with drugs having other indications; possible genetic confounders; and too much heterogeneity of studies for meta-analyses. There were balancing limitations possibly tending towards underestimates of risk such as limited power, excessive follow-up intervals with possible follow-up mixing of participants taking hypnotics with controls, missing dosage data for most studies, and over-adjustment of confounders. Epidemiologic association in itself is not adequate proof of causality, but there is proof that hypnotics cause death in overdoses; there is thorough understanding of how hypnotics euthanize animals and execute humans; and there is proof that hypnotics cause potentially lethal morbidities such as depression, infection, poor driving, suppressed respiration, and possibly cancer. Combining these proofs with consistent evidence of association, the great weight of evidence is that hypnotics cause huge risks of decreasing a patient's duration of survival. Key PointsMost sleeping pills e.g., benzodiazepines and ''Z'' benzodiazepine agonists (like eszopiclone) are associated with early death, and they most probably cause serious increases in mortality.Benzodiazepine agonist sleeping pills and diphenhydramine should not be prescribed for insomnia, except in long-term controlled trials and hospice care.

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“…helpful in clarifying problems with rebound criteria in the three studies on which I had commented [1,2]. Most important, "rebound insomnia" is not a suitable criterion for lasting insomnia after drug withdrawal, especially not when defined as insomnia exceeding baseline.…”

mentioning

confidence: 99%

“Rebound” is not an appropriate criterion for withdrawal insomnia11Dr Kripke's response (rebuttal) to Dr Mayer and Dr Rodenbeck's letter published in Sleep Med 2014;15:1169–71.

Hypnotics cause insomnia: evidence from clinical trials

Cited by 8 publications

References 4 publications

Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Mortality Risk of Hypnotics: Strengths and Limits of Evidence

“Rebound” is not an appropriate criterion for withdrawal insomnia11Dr Kripke's response (rebuttal) to Dr Mayer and Dr Rodenbeck's letter published in Sleep Med 2014;15:1169–71.

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