Effects of hypnotics on sleep and quality of life in insomnia

Abstract

This chapter provides an overview of the effects of hypnotics on sleep and quality of life (QOL). In the 1970s it was accepted that a consequence of taking longer acting benzodiazepine hypnotics was a residual hangover next day, producing feelings of sedation and impaired performance. The realization during the 1980s that insomnia was not just a subjective complaint of poor sleep, but in itself resulted in impaired functioning with increased accident risk, led to studies evaluating the effects of sleep medication on both sleep and waking function including QOL. The potentially impairing effects of hypnotic treatment therefore need to be weighed up against the costs and consequences of untreated insomnia. The emergence of the newer benzodiazepine receptor agonists (BzRAs) zopiclone, zolpidem and zaleplon (Z drugs) with their shorter half-lives and reduced levels of residual impairment, tolerance and dependency, particularly for zolpidem and zaleplon, shift the balance in favour of safer hypnotic treatment, so that insomnia should no longer go unrecognized and untreated in so many. Guidelines for limiting hypnotic prescriptions to a few weeks resulted from the association of long-term benzodiazepine use with tolerance and therefore lack of treatment benefit, as well as the associated risks of dependence occurring with some compounds. These guidelines are at odds with the significant number of chronic insomniacs, often elderly patients, who require long-term treatments. There is now limited evidence that newer formulations and different treatment schedules, including intermittent use, can sustain hypnotic efficacy with the Z drugs over longer periods, enhancing QOL and waking function, and without rebound insomnia following withdrawal. Similarly, behavioural and psychological approaches may be beneficial in the long term for some, though possible treatment limitations amongst different types of patients have still to be defined. © 2008 Humana Press, Totowa, NJ.