Hyperarousal/Sleep Disturbance and Inability to Discontinue Chronic Hypnotic Use
Recommended Citation
Roehrs T, Koshorek G, Roth T. Hyperarousal/Sleep Disturbance and Inability to Discontinue Chronic Hypnotic Use. Drug Alcohol Depend 2024; 260.
Document Type
Conference Proceeding
Publication Date
7-1-2024
Publication Title
Drug Alcohol Depend
Abstract
Select Drug Category Sedative/Hypnotics Topic Behavior Abstract Detail Clinical – Experimental Abstract Category Original Research Aim: Inability to discontinue hypnotics remains a concern among clinicians. In a controlled prospective study using self-administration choice procedures we tested whether baseline sleep disturbance (SE<85%) and hyperarousal (MSLT>12 min), alone or in combination, would predict discontinuation difficulty after 6 months of nightly hypnotic use. Methods: DSM-V diagnosed insomnia subjects, 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 screening polysomnogram and MSLT, participants were randomized to zolpidem XR 12.5 mg (n=16), eszopiclone 3 mg (n=11), or placebo (n=14) nightly for 6 months. After 6 months, nightly use, over a 2-week choice period, they were instructed to discontinue 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). Results: Over the 14 nights 21 subjects took zero (51%) capsules; among the 20 taking capsules the median total number chosen over the two weeks was 3. The three treatment groups did not differ in baseline SE and MSLT. Across the three groups, the number of capsules taken declined from week 1 to 2 (p<.001). Those with both MSLT >12 min and SE<85% (n=14) did not reduce capsule choice (i.e., continued capsule use at the same rate) from week 1 to 2 (p<.04) relative to the rest of the subjects. Neither MSLT nor SE alone predicted discontinuation difficulty. Conclusions: The majority (51%) of the participants discontinued 6-month nightly hypnotic use and among those taking capsules the rate declined from week 1 to 2. Hyperarousal and sleep disturbance may help identify those with difficulty discontinuing chronic hypnotic use. Financial Support: The majority (51%) of the participants discontinued 6-month nightly hypnotic use and among those taking capsules the rate declined from week 1 to 2. The non-hypnotic receptor specific eszopiclone group took a greater number of capsules than the placebo group. This is the first demonstration of differential abuse liability among BzRA hypnotics.
Volume
260
