title: Durability of treatment response to zolpidem with three different maintenance regimens: a preliminary study.
abstract: OBJECTIVE
  At present, there is no consensus regarding how to medically manage chronic insomnia in the long term. The unstated standard of practice is for patients to use hypnotics intermittently. The present study aimed to compare a partial reinforcement strategy with nightly and intermittent dosing strategies for its potential as a maintenance therapy.
  
  
  METHODS
  A mixed model was used in the study. One between-subjects factor: group (n = 4). One repeated-measures factor: time (12 weekly assessments). A total of 74 subjects with chronic Insomnia were treated with 10 mg zolpidem for 4 weeks. Treatment respondents were randomized to nightly dosing with 10 mg or 5 mg (QHS-10 and QHS-5), intermittent dosing with 10 mg (IDS-10 [3-5 days weekly]), or partial reinforcement dosing with 10 mg (PRS-10 [nightly pill use with 50% active medication and 50% placebos]) for 12 weeks.
  
  
  RESULTS
  It was found, in compliant subjects (n = 55), that all four strategies evaluated maintained treatment response over time (ie, prevented or delayed relapse). For the subjects that remained in remission, the subjects in the intermittent dosing group (IDS-10) group exhibited poorer sleep continuity.
  
  
  CONCLUSIONS
  While best considered a preliminary study, the present findings suggest that the partial reinforcement strategy may be a viable means toward maintaining treatment gains over time with less active medication.
authors: Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA; School or Nursing, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: mperlis@upenn.edu.
authors: Michael
authors: M
authors: Perlis
authors: Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Michael
authors: M
authors: Grandner
authors: Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Jarcy
authors: J
authors: Zee
authors: Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
authors: Erin
authors: E
authors: Bremer
authors: Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
authors: Julia
authors: J
authors: Whinnery
authors: Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
authors: Holly
authors: H
authors: Barilla
authors: Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
authors: Priscilla
authors: P
authors: Andalia
authors: Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Phil
authors: P
authors: Gehrman
authors: Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
authors: Knashawn
authors: K
authors: Morales
authors: Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; Mood and Anxiety Disorders Treatment and Research Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
authors: Michael
authors: M
authors: Thase
authors: Department of Psychology, University of Arizona, Tucson, AZ, USA.
authors: Richard
authors: R
authors: Bootzin
authors: Department of Psychiatry, University of Rochester, Rochester, NY, USA.
authors: Robert
authors: R
authors: Ader
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D055118:Medication Adherence; D011725:Pyridines / Q000008:administration & dosage*; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D016896:Treatment Outcome; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem
keywords: Insomnia; Maintenance therapy; Partial reinforcement; Placebos; Zolpidem