Are people with severe insomnia able to discontinue hypnotics after chronic use?
Koshorek G, Verkler J, Withrow D, Roth T, and Roehrs T. Are people with severe insomnia able to discontinue hypnotics after chronic use? Sleep 2019; 42(Suppl 1):A153-A154.
Introduction: A concern among physicians prescribing hypnotics is the inability to discontinue hypnotics after chronic use. This concern has never been directly tested in a controlled prospective study. This is a report of results from an on-going “blinded” trial in which insomnia subjects are instructed to stop taking study medication after 6 months of nightly use. Methods: DSM-V diagnosed insomnia subjects, 23-61 yrs, (n=25, 21 females), with disturbed sleep (i.e. polysomnographic sleep efficiency of ≤85%), no other sleep disorder, unstable medical or psychiatric disorder or drug dependency completed the trial. Participants were randomized to zolpidem XR (12.5 mg), eszopiclone (3 mg) or placebo nightly for 6 months (groups A: n=10, B: n=6, C: n=9). After 6 months of nighty use, over a 2-week choice period, they were instructed to discontinue hypnotic use, but if necessary, to take either 1, 2, or 3 capsules of medication (zolpidem XR 6.25 mg, 6.25 mg, placebo; eszopiclone 2 mg, 1 mg, placebo 1, 2 and 3 respectively; or 3 placebos). Results: The number of capsules taken declined from week 1 to 2 (p< .01). Over 2 weeks 13 participants took 0 (48%), 8 ≤ 6 (32%) and 4 ≥10 capsules (1 each took 42, 19, 13, and 10). Among those taking capsules most took one capsule per night and 9 took > 1 capsule. Those 4 taking ≥ 10 were younger (p<.05), but did not differ in screening sleep efficiency or blinded treatment group. Importantly 1 subject took every capsule available. Conclusion: The majority (80%) of the participants discontinued 6-month nightly hypnotic use (i.e. took < 6 total capsules over 2 weeks) and among those taking capsules the rate declined from week 1 to 2. Age may help identify the few with difficulty discontinuing.