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The Efficacy and Safety of Long-Term Use of Hypnotics
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Insomnia may present with a variety of complaint and etiology, making the evaluation and management of chronic insomnia demanding on a clinician’s time. Long-term use of hypnotics and sedatives has been discouraged for a number of reasons, including tolerance, abuse liability, and the belief that insomnia is a symptom that remit with treatment of the underlying medical or psychiatric disorder. Moreover, pharmacotherapy produces only moderate improvement during drug administration and returns toward baseline after discontinuation. Although efficacy and safety have been established for benzodiazepine receptor agonists when used for short-duration therapy, there are few data that establish their continued efficacy and safety in long-term use. Benzodiazepine hypnotics have been implicated as a cause of numerous adverse events, including dependency, withdrawal, rebound symptom, daytime sedation, fall, and hip fracture, especially in older people. In order to use hypnotic properly, correct diagnosis of the underlying causes of sleep disturbance is acquired at first and extreme caution of hypnotics use to primary sleep disorders is needed, especially in sleep related breathing disorders. Physicians and patients should be cautioned about the potential adverse effects and using of hy-pnotics. After initial treatment, clinical efficacy and side effect should be observed regularly. Easy accessibility of cognitive behavior therapy for patient can be also a coping with long-term use of hypnotics.
Abstract
Insomnia may present with a variety of complaint and etiology, making the evaluation and management of chronic insomnia demanding on a clinician’s time. Long-term use of hypnotics and sedatives has been discouraged for a number of reasons, including tolerance, abuse liability, and the belief that insomnia is a symptom that remit with treatment of the underlying medical or psychiatric disorder. Moreover, pharmacotherapy produces only moderate improvement during drug administration and returns toward baseline after discontinuation. Although efficacy and safety have been established for benzodiazepine receptor agonists when used for short-duration therapy, there are few data that establish their continued efficacy and safety in long-term use. Benzodiazepine hypnotics have been implicated as a cause of numerous adverse events, including dependency, withdrawal, rebound symptom, daytime sedation, fall, and hip fracture, especially in older people. In order to use hypnotic properly, correct diagnosis of the underlying causes of sleep disturbance is acquired at first and extreme caution of hypnotics use to primary sleep disorders is needed, especially in sleep related breathing disorders. Physicians and patients should be cautioned about the potential adverse effects and using of hy-pnotics. After initial treatment, clinical efficacy and side effect should be observed regularly. Easy accessibility of cognitive behavior therapy for patient can be also a coping with long-term use of hypnotics.
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