Long-term use of sedative hypnotics in older patients with insomnia.
OBJECTIVE
Insomnia is a common problem that increases with age and can last months to years. While substantial data establish the efficacy and safety of short-acting hypnotic therapy for the management of short-term insomnia using benzodiazepines receptor agonists (BzRAs), there are few studies on the continued efficacy and safety of these drugs when used for sustained periods. This paper reports the results of a 1-year open-label extension phases of two randomized, double-blind trials of zaleplon.


METHODS
In the open-label phase, older patients self-administered zaleplon nightly from 6 to 12 months and were then followed through a 7-day single-blind placebo-controlled run-out period.


RESULTS
The safety profile in this population of older adults was similar to that observed in a short-term trial of an equivalent population. The data also suggested that long-term therapy produced and maintained statistically significant improvement in time to persistent sleep onset, duration of sleep and number of nocturnal awakenings (P<0.001 for each variable) for treatment durations of up to 12 months. Discontinuation was not associated with rebound insomnia.


CONCLUSIONS
The open-label trial of long-term hypnotic therapy with zaleplon 5 and 10 mg suggests that they are safe and effective for the treatment of insomnia in older patients. Placebo-controlled, double-blind trials are needed in zaleplon and other BzRAs to confirm these results.
Ancoli-Israel
Sonia
S
Department of Psychiatry 116A, University of California San Diego and Veterans Affairs, San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA. sancoliisrael@ucsd.edu
Richardson
Gary S
GS
Mangano
Richard M
RM
Jenkins
Lisa
L
Hall
Phil
P
Jones
Walter S
WS
D000081:Acetamides / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011725:Pyridines / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D011743:Pyrimidines / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D011963:Receptors, GABA-A / Q000378:metabolism; D016037:Single-Blind Method; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D013995:Time; D014851:Wakefulness / Q000187:drug effects; D000077334:Zolpidem
D000081:Acetamides; D006993:Hypnotics and Sedatives; D011725:Pyridines; D011743:Pyrimidines; D011963:Receptors, GABA-A; D000077334:Zolpidem; C085665:zaleplon