title: Middle-of-the-night hypnotic use in a large national health plan.
abstract: OBJECTIVE
  Although difficulty maintaining sleep (DMS) is the most common nighttime insomnia symptom among US adults, many FDA-approved hypnotics have indications only for sleep onset, stipulating bedtime administration to offset residual sedation. Given the well-known self-medication tendencies of insomniacs, concern arises that maintenance insomniacs might be prone to self-administer their prescribed hypnotics middle-of-the-night (MOTN) after nocturnal awakenings, despite little efficacy-safety data supporting such use. However, no US data characterize the actual population prevalence or correlates of MOTN hypnotic use.
  
  
  METHODS
  Telephone interviews assessed patterns of prescription hypnotic use in a national sample of 1,927 commercial health plan members (ages 18-64) receiving prescription hypnotics within 12 months of study. The Brief Insomnia Questionnaire assessed insomnia symptoms.
  
  
  RESULTS
  20.2% of respondents reported MOTN hypnotic use, including 9.0% who sometimes used twice-per-night (once at bedtime plus once MOTN) and another 11.2% who sometimes used MOTN, but never twice-per-night. The remaining 79.8% used exclusively at bedtime. Among exclusive MOTN users, only 14.0% used MOTN on the advice of their physician (52.6% of those seen by sleep medicine specialists and 42.6% by psychiatrists vs. 5.2% to 13.6% seen by other physicians). MOTN use predictors included DMS being the most bothersome sleep problem, long duration of hypnotic use, and low frequency of DMS.
  
  
  CONCLUSIONS
  One-fifth of patients with prescription hypnotics used MOTN, only a minority on advice from their physicians. Since significant next-day cognitive and psychomotor impairment is documented with off-label MOTN hypnotic use, prescribing physicians should question patients about unsupervised MOTN dosing.
authors.affiliation: Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Roth
authors.forename: Patricia
authors.initials: P
authors.lastname: Berglund
authors.forename: Victoria
authors.initials: V
authors.lastname: Shahly
authors.forename: Alicia C
authors.initials: AC
authors.lastname: Shillington
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Stephenson
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000293:Adolescent; D000328:Adult; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives
keywords: Insomnia; dosing; hypnotics; medication adherence; middle-of-the-night; prevalence; sleep maintenance