Dose determinants of rebound insomnia.

Roehrs, T; Zorick, F; Wittig, R; Roth, Thomas

doi:10.1111/j.1365-2125.1986.tb05241.x

Cited by 33 publications

(13 citation statements)

References 16 publications

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“…Conversely, the withdrawal from long-acting FLU was not found to be milder. Both withdrawal schemes involved gradual tapering, and this may be responsible for the relative ease in withdrawal in both groups (Roehrs et al 1986). …”

Section: Discussionmentioning

confidence: 97%

The effects of substituting zopiclone in withdrawal from chronic use of benzodiazepine hypnotics

et al. 1998

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Twenty-four volunteers (19 women and five men) with insomnia and a history of chronic use of benzodiazepine hypnotics participated in a randomized, double blind, controlled clinical trial. The study was designed to assess the effects of substituting zopiclone (ZOP)- as an hypnotic- among chronic users of flunitrazepam (FLU), and to compare the subsequent withdrawal of ZOP with placebo controlled withdrawal of FLU. During the 5 weeks of a withdrawal protocol, sleep and physiological parameters were assessed by polysomnographic measures for 11 nights and by nightly actigraphic recordings for weeks 1, 3, and 5. Subjective effects of the withdrawal process were evaluated with daily sleep diaries, and with various weekly self-report symptom checklists. Paired t-tests performed on differences in objective sleep parameters between baseline and the last weeks of the withdrawal program showed a significant decrease in sleep quality within the FLU group, but not in the ZOP group. Subjective sleep diaries consistently reflected the objectively measured changes in sleep throughout the withdrawal program, indicating significant changes in sleep parameters only in the FLU group. The results obtained from the self report inventories aimed at assessing withdrawal symptoms, however, revealed no differences between the baseline week and the termination week of the program in any of the groups. After completing the pharmacological withdrawal, all subjects received a short-term cognitive behavioral intervention focused on improving their coping strategies with symptoms of insomnia; they were evaluated immediately after concluding the intervention, and at 3 and 12 month follow- ups.

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Section: Discussionmentioning

confidence: 97%

The effects of substituting zopiclone in withdrawal from chronic use of benzodiazepine hypnotics

et al. 1998

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“…The most important determinant of rebound insomnia is dose. Clinical doses are rarely associated with rebound, whereas doses greater than the clinical dose are more likely to produce rebound [38]. The duration of use of clinical doses is also not associated with an enhanced likelihood of rebound.…”

Section: Rebound Insomniamentioning

confidence: 90%

Insomnia Pharmacotherapy

2012

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Summary The benzodiazepine receptor agonists (BzRAs) a melatonin receptor agonist and a histamine antagonist have all been approved as hypnotics. Beyond their differing mechanisms of action, they have differences in pharmacokinetics, and among the BzRAs differences in receptor subtype affinity and formulations, which provides the physician with broad options for tailoring therapy to each patient's specific needs. Consistent with their specific pharmacokinetics and formulations, these Food and Drug Administration-approved hypnotics have been shown to improve sleep with no evidence of tolerance development in long-term use. In addition, emerging data indicate these drugs also improve aspects of daytime function. Their side effects are either associated with the direct sedating effects of the drugs, doses greater than clinical doses, or a combination with alcohol or other sedating drugs. Anxiolytic BzRAs, sedating antidepressants and antipsychotics have been used off-label as hypnotics. However, in the absence of information regarding their dose range for efficacy and safety, their use as hypnotics is ill-advised.

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“…53,54 The rebound insomnia associated with the discontinuation of benzodiazepines manifests as a rapid return of original symptoms of difficulty with sleep initiation and/or maintenance, but worse than before treatment. 44,53,55 Rather than abrupt discontinuation, gradual tapering of the benzodiazepine by 10% or less at 5-7-day intervals is recommended in patients who have been taking a high dose for a prolonged period of time. 53 Withdrawal seizures associated with discontinuation of benzodiazepines are rare.…”

Section: Adverse Effectsmentioning

confidence: 99%

Therapeutic Options for Sleep‐Maintenance and Sleep‐Onset Insomnia

2007

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Insomnia, defined as difficulty falling asleep, staying asleep, and/or experiencing restorative sleep with associated impairment or significant distress, is a common condition resulting in significant clinical and economic consequences. Many options are available to treat insomnia, to assist with either falling asleep (sleep onset) or maintaining sleep. We searched MEDLINE for articles published between January 1996 and January 2006, evaluated abstracts from recent professional meetings, and contacted the manufacturer of the most recent addition to the pharmacologic armamentarium for insomnia treatment (ramelteon) to gather information. Nonpharmacologic options include stimulus control, sleep hygiene education, sleep restriction, paradoxical intention, relaxation therapy, biofeedback, and cognitive behavioral therapy. Prescription and over-the-counter drug therapies include benzodiazepine and nonbenzodiazepine sedative-hypnotic agents; ramelteon, a melatonin receptor agonist; trazodone; and sedating antihistamines. Herbal and alternative preparations include melatonin and valerian. Before recommending any treatment, clinicians should consider patient-specific criteria such as age, medical history, and other drug use, as well as the underlying cause of the sleep disturbance. All pharmacotherapy should be used with appropriate caution, at minimum effective doses, and for minimum duration of time.

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Dose determinants of rebound insomnia.

Cited by 33 publications

References 16 publications

The effects of substituting zopiclone in withdrawal from chronic use of benzodiazepine hypnotics

The effects of substituting zopiclone in withdrawal from chronic use of benzodiazepine hypnotics

Insomnia Pharmacotherapy

Therapeutic Options for Sleep‐Maintenance and Sleep‐Onset Insomnia

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