Long-term use of sedative hypnotics in older patients with insomnia

Ancoli‐Israel, Sonia; Richardson, Gary S.; Mangano, Richard M.; Jenkins, Lisa M. Miller; Hall, Phil; Jones, Walter S.

doi:10.1016/j.sleep.2004.10.015

Cited by 140 publications

(74 citation statements)

References 13 publications

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“…Participants randomized to any zaleplon dose were more likely than placebo participants to report improved sleep quality at week 4 (57% vs. 48%) (moderate strength of evidence) (Figure 29). 111,112 Individually, zaleplon doses of 5 and 20 mg, but not 10 mg, were superior to placebo in improving sleep quality at week 4 (57% vs. 48% and 60% vs. 48%, respectively). …”

Section: Sleep Outcomesmentioning

confidence: 98%

“…60,[111][112][113][114][115] Treatment duration was between 4 and 6 weeks for five of the trials. One trial was longer-term, with treatment duration up to 8 months.…”

Section: Overview Of Studiesmentioning

confidence: 99%

“…Five trials were conducted in the United States 60,[112][113][114][115] and one in Europe and Canada. 111 Four trials evaluated a 10 mg dose 60,111,112,115 and two trials evaluated 10 and 15 mg doses. 113,114 One trial administered a 5 mg dose for participants 60 years of age or older.…”

Section: Overview Of Studiesmentioning

confidence: 99%

“…113 Elie reported that zolpidem was no more effective than placebo in improving sleep onset latency at week 4. 111 Moderate strength evidence shows that zolpidem improved sleep quality or the proportion of participants "getting a better night's sleep" more than placebo (69% vs. 49%) (Figure 31). Lahmeyer et al reported that 10 and 15 mg zolpidem improved clinical global impression of sleep quality over placebo (both 84% vs. 49%).…”

Section: Sleep Outcomesmentioning

confidence: 99%

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Cognitive Behavioral Therapy in the Treatment of Insomnia

Haynes¹,

Talbert²,

Fox³

et al. 2018

Southern Medical Journal

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Section: Sleep Outcomesmentioning

confidence: 98%

“…60,[111][112][113][114][115] Treatment duration was between 4 and 6 weeks for five of the trials. One trial was longer-term, with treatment duration up to 8 months.…”

Section: Overview Of Studiesmentioning

confidence: 99%

Section: Overview Of Studiesmentioning

confidence: 99%

Section: Sleep Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

Cognitive Behavioral Therapy in the Treatment of Insomnia

Haynes¹,

Talbert²,

Fox³

et al. 2018

Southern Medical Journal

View full text Add to dashboard Cite

“…129 A similar short-term study investigating the use of zaleplon (5-10 mg) in elderly individuals (mean 72.5 years of age) was extended to a single-blinded, open-label phase, with favorable results up to 12 months. 130 …”

Section: Hypnoticsmentioning

confidence: 99%

Circadian rhythm sleep disorders

Kolla¹,

Auger²,

Morgenthaler³

2012

CPT

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Misalignment between endogenous circadian rhythms and the light/dark cycle can result in pathological disturbances in the form of erratic sleep timing (irregular sleep-wake rhythm), complete dissociation from the light/dark cycle (circadian rhythm sleep disorder, free-running type), delayed sleep timing (delayed sleep phase disorder), or advanced sleep timing (advanced sleep phase disorder). Whereas these four conditions are thought to involve predominantly intrinsic mechanisms, circadian dysrhythmias can also be induced by exogenous challenges, such as those imposed by extreme work schedules or rapid transmeridian travel, which overwhelm the ability of the master clock to entrain with commensurate rapidity, and in turn impair approximation to a desired sleep schedule, as evidenced by the shift work and jet lag sleep disorders. This review will focus on etiological underpinnings, clinical assessments, and evidence-based treatment options for circadian rhythm sleep disorders. Topics are subcategorized when applicable, and if sufficient data exist. The length of text associated with each disorder reflects the abundance of associated literature, complexity of management, overlap of methods for assessment and treatment, and the expected prevalence of each condition within general medical practice.

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Insomnia

Buysse¹

2013

JAMA

811

556

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Key Clinical Question-How does one diagnose and treat insomnia in adults?Evidence Review-Summary of meta-analyses of chronic insomnia treatments.Bottom Line-Insomnia is a common clinical condition characterized by difficulty initiating or maintaining sleep, accompanied by symptoms such as irritability or fatigue during wakefulness. The prevalence of insomnia disorder is approximately 10-20%, with approximately 50% having a chronic course. Insomnia is a risk factor for impaired function, the development of other medical and mental disorders, and increased health care costs. The etiology and pathophysiology of insomnia involve genetic, environmental, behavioral, and physiological factors culminating in hyperarousal. Efficacious treatments for insomnia include behavioral, cognitive, and pharmacologic interventions. Simple behavioral interventions are feasible in primary care settings, but lack of training in these techniques limits their use. Among pharmacologic interventions, the most evidence exists for benzodiazepine receptor agonist drugs, although persistent concerns focus on their safety relative to modest efficacy. Behavioral treatments should be used whenever possible, and medications should be limited to the lowest necessary dose and shortest necessary duration. Dr. ShipMs. J is a 51-year-old woman with insomnia, which began at age 35 when her infant daughter had very disrupted sleep. By the age of 7, her daughter's sleep was improved, but Ms. J's was not. She was able to fall asleep, but was unable to stay asleep after about 3 in the morning. Ms. J tried several medications with variable success and side effects. She currently takes gabapentin, which is working well. She is very attentive to "sleep hygiene," and maintains a regular bedtime and waking time. M.s J's past medical history is notable for mild depression, Raynaud's Syndrome and myelodysplasia/myelofibrosis. Ms. J works as an educational consultant. She lives with her husband and two teenage children. She exercises regularly by swimming, cycling, and running. She does not use tobacco and has 1/2 glass of wine 3 nights per week. Current medications include escitalopram 20 mg daily, gabapentin 1200 mg qhs, and nifedipine SR 60 mg daily in cold weather. Ms. J has no drug allergies. On physical examination, Ms. J is healthy and fit. Weight is 121 pounds, blood pressure 119/64, and pulse 68 beats per minute.

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Long-term use of sedative hypnotics in older patients with insomnia

Cited by 140 publications

References 13 publications

Cognitive Behavioral Therapy in the Treatment of Insomnia

Cognitive Behavioral Therapy in the Treatment of Insomnia

Circadian rhythm sleep disorders

Insomnia

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