BzRA Hypnotic Receptor Specificity and Rebound Insomnia

Document Type

Conference Proceeding

Publication Date

5-19-2025

Publication Title

Sleep

Abstract

Introduction: Discontinuing hypnotics after chronic use remains a concern, which has never been directly tested in a controlled, blinded, prospective study using self-administration choice pro cedures. We report on discontinuation predictors in a clinical trial in which persons with insomnia were instructed to stop tak ing medication after 6 months of nightly use. Methods:: Insomnia participants aged 23-61 yrs, (n=41, 36 females), with no other sleep disorders, unstable medical or psychiatric diseases or drug dependency completed the trial. Following a NPSG participants were randomized to zolpidem XR (12.5 mg), eszopiclone (3 mg), or placebo nightly for 6 months. After 6 months nightly use, over a 2-week discontinua tion, they were instructed to discontinue their hypnotic use, but if necessary, to self-administer either 1, 2, or 3 capsules of their assigned “blinded” medication (zolpidem XR 6.25 mg, 6.25 mg, placebo; eszopiclone 2 mg, 1 mg, placebo as capsules 1, 2 and 3 respectively; or 3 placebos). Sleep was recorded by actigraphy on a baseline week and during the two discontinuation weeks and scored for latency to sleep (LAT min), wake during sleep (WASO min), and sleep efficiency (SE %). Rebound insomnia was tested by comparing baseline nt 1 to discontinuation nts 1 & 2. Results: Over the 14 nights 21 participants took zero (51%) cap sules and among the 20 taking capsules the median total number chosen was 3. During the two-week discontinuation the BzRA receptor non-specific hypnotic, eszopiclone, was associated with a significantly greater (p<.005) number of capsule choices than the placebo group with the zolpidem group (BzRA receptor specific) not different than placebo. Compared to baseline, on discontinuation night 1 the eszopiclone group had greater WASO (i.e. rebound insomnia +10.2 +/-8.4 min), differing (p <.05) from the placebo (-9.3 +/-6.3 min) and zolpidem (-12.2+/8.5 min) groups which did not experience rebound insomnia. No rebound insomnia on discontinuation nt 2 in any of the three groups. Conclusion: Fifty-one percent discontinued 6-months of nightly hypnotic use. The BzRA receptor non-specific hypnotic group, eszopiclone, self-administered a greater number of capsules during the two-week discontinuation and experienced rebound insomnia on discontinuation night 1.

Volume

48

First Page

A238

Last Page

A239

Find It @ Sladen

Share

COinS