0408 A Blinded Hypnotic Tapering Approach for Hypnotic discontinuation

Abstract

Introduction: Hypnotic users commonly make unsuccessful attempts to discontinue their hypnotics. This study tested a blinded tapering approach to reduce anxiety and help patients discontinue their hypnotics. Methods: This study enrolled 78 (M age = 55.2 ± 12.8 yrs.; 65.4% women) users of benzodiazepine and benzodiazepine receptor agonists. Enrollees completed baseline measures including the Insomnia Severity Index (ISI). They then completed 4 sessions of cognitive behavioral insomnia therapy (CBTI). Subsequently they were randomized to one of three 20‐week, double‐blinded tapering protocols wherein their medication dosage was either reduced by 25% or 10% every two weeks, or remained unchanged (CTRL). During tapering, all enrollees were seen biweekly by the study physician for support and guidance. At the end of the 20‐week period the study blind was eliminated and those who completed one of the two blinded tapering protocols entered a 3‐month follow‐up period, whereas CTRL participants are offered an open label taper before completing the follow‐up. Results: Baseline ISI scores (ISI=18.07±0.58) showed that the total sample entered the trial with moderately severe insomnia complaints despite almost nightly hypnotic use. These scores declined into the mild range after CBTI (10.19±0.53) and tapering (9.62±.63) and approached the normative range by follow‐up (7.59±1.05). Of the 45 who completed one of the blinded tapering protocols to date, 39 (86.7%) totally discontinued their medication use by the end of the 20‐week tapering phase whereas 12 (75%) of 16 in the CTRL group discontinued hypnotic use by the end of their open label tapering. At follow‐up 22 of 30 (73.3%) who completed blinded tapering remained medication free whereas only 5 of 14 (35.7%) in the CTRL group who underwent open‐label tapering remained medication free. Conclusion: CBTI combined with blinded hypnotic tapering seems a promising treatment approach to help hypnotic users overcome their medication dependence and improve insomnia symptoms.