New epidemiologic findings about insomnia and its treatment.
This paper examines several clinical concerns about the shorter half-life benzodiazepine hypnotics from an epidemiologic perspective. It draws on data from (1) 1979 and 1990 comprehensive probability-based U.S. national household surveys of the medical use of psychotherapeutic medications; (2) a 1990 four-city community-based volunteer call-in survey of the beneficial and adverse effects of hypnotics; and (3) an analogous random-digit dialing telephone survey in the general population. The issues addressed are abuse liability, rebound, depersonalization/derealization, paranoid feelings, accidents/injuries, and the unexamined consequences of the target illness in assessments of benefit-risk. In populations representative of everyday outpatient practice, we found that (1) the abuse liability of benzodiazepine hypnotics with shorter and longer elimination half-lives was generally low and comparable; (2) prevalence rates for rebound were low and not differential for flurazepam, temazepam, triazolam, and OTC sleeping pills; (3) reports of a single or an occasional experience involving depersonalization/derealization or paranoid feelings were fairly frequent in normals, in insomnia patients prior to treatment, and in persons with untreated insomnia; (4) treatment-emergent rates of occurrence for these same symptoms were low and not drug-specific; (5) past-year prevalence rates for serious accidents/injuries were much higher for chronic untreated insomnia than for normal controls and most groups treated with psychotherapeutic medications. A high proportion of past-year users of hypnotics were satisfied with their medication and would take it again.
Balter
M B
MB
Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, Boston, Mass.
Uhlenhuth
E H
EH
D000059:Accidents / Q000706:statistics & numerical data; D001294:Attitude to Health; D001569:Benzodiazepines / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D003861:Depersonalization / Q000139:chemically induced / Q000453:epidemiology / Q000523:psychology; D004363:Drug Utilization / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001523:Mental Disorders / Q000139:chemically induced / Q000453:epidemiology / Q000523:psychology; D010259:Paranoid Disorders / Q000139:chemically induced / Q000453:epidemiology / Q000523:psychology; D010349:Patient Compliance; D015995:Prevalence; D012008:Recurrence; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000453:epidemiology; D013689:Telephone; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology
D006993:Hypnotics and Sedatives; D001569:Benzodiazepines