Magic bullets for insomnia? Patients' use and experiences of newer (Z drugs) versus older (benzodiazepine) hypnotics for sleep problems in primary care

Siriwardena, Aloysius Niroshan; Qureshi, Myra; Dyas, Jane; Middleton, Hugh; Ørner, Roderick

doi:10.3399/bjgp08x299290

Cited by 111 publications

(76 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In contrast to physician-assumed patient preferences for hypnotics, many patients actually express an inclination towards ceasing medication because of unpleasant side effects (Siriwardena, Qureshi, Dyas, Middleton, & Orner, 2008). However when hypnotic prescriptions are written unquestioningly by physicians, patients assume extended use is safe and justified (Barter & Cormack, 1996;Iliffe, Curran, Collins, Yuen Kee, Fletcher, & Woods, 2004;King, Gabe, Williams, & Rodrigo, 1990).…”

Section: Downloaded By [Michigan State University] At 21:44 07 Februamentioning

confidence: 94%

The Insomnia Patient Perspective, A Narrative Review

Cheung

Bartlett

Armour

et al. 2013

Behavioral Sleep Medicine

View full text Add to dashboard Cite

Insomnia is a common sleep disorder associated with substantial direct and indirect costs, yet there is a strong propensity among patients to self-medicate which often delays professional help. Understanding the process which underpins the initiation, engagement and adherence to insomnia treatment(s) is a vital step for understanding this phenomenon. The current paper explores how the patient perspective has been conceptualized in the research literature and its implications for insomnia treatment and health care delivery. A literature search was conducted using Embase, Medline and PsycINFO databases. Articles have been thematically organized into patient correlates of health behaviors, patient experiences and treatment attitudes. Deferral of professional help among insomnia patients is partially related to barriers embedded in the health care system and patient health beliefs.

show abstract

Section: Downloaded By [Michigan State University] At 21:44 07 Februamentioning

confidence: 94%

The Insomnia Patient Perspective, A Narrative Review

Cheung

Bartlett

Armour

et al. 2013

Behavioral Sleep Medicine

View full text Add to dashboard Cite

show abstract

“…36,37 The prevalence of inappropriate psychotropic drug use is comparable to the percentages found in Sweden, specifically regarding the use of long-acting benzodiazepines or the concomitant use of three or more psychotropic drugs. 35 The present study highlights the excessive duration of psychotropic treatments, particularly for benzodiazepines and Zdrugs. Although antidepressants can be indicated for long-term treatment, 38 hypnotics are not recommended for longer than 1 month, and anxiolytics are recommended for no longer than 3 months.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…In Sweden and in the UK, Z-drugs are more frequently prescribed than the conventional benzodiazepines. 35 However, both treatments (benzodiazepines and Z-drugs) should be used with caution. 36,37 The prevalence of inappropriate psychotropic drug use is comparable to the percentages found in Sweden, specifically regarding the use of long-acting benzodiazepines or the concomitant use of three or more psychotropic drugs.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Psychotropic drug use among older people in general practice: discrepancies between opinion and practice

Lasserre

Younès

Blanchon³

et al. 2010

Br J Gen Pract

View full text Add to dashboard Cite

The use of psychotropic drugs has increased over recent years in France. GPs are the first prescribers, especially for older patients. AimTo analyse discrepancies between GPs' opinions and practice when prescribing psychotropic drugs to older patients. SettingPostal surveys sent to GPs all over mainland France. Design of studyCross-sectional postal study. MethodA questionnaire collected data on characteristics of GPs' practices, their opinions about psychotropic drug consumption in older people, and a full description of their last older patient receiving a psychotropic drug and seen last by the GP on that particular day. ResultsA total of 350 participating GPs saw 2498 patients aged ≥65 years. Among these patients, the prevalence of psychotropic use was 32.1% (803/2498) for anxiolytics/hypnotics, and 17.5% for antidepressants (438/2498). A total of 91% of GPs agreed that it was possible to reduce or stop psychotropic drugs for these patients. Characteristics of 339 patients taking psychotropic drug were reported: 85.8% (291/339) received at least one anxiolytic/hypnotic and 56.9% (193/339) received at least one antidepressant; there were prescribed for more than 1 year in 68.4% (199/291) and 43.5% (84/193) of the cases respectively. GPs stated that it was possible to reduce or stop anxiolytic/hypnotic drugs for only 27% (79/291) of these patients. Barriers to doing this were patients' refusal (79%), and the absence of any local offer of psychotherapy (73%) or alternative therapy (70%). ConclusionA mismatch exists between GPs' intent (91%) and practice (27%) regarding reduction of psychotropic prescription in individuals aged ≥65 years. The barriers encountered should be examined further to help physicians improve management of psychotropic prescription.

show abstract

“…11,12 To provide better management and improve the user experience of care of sleep problems, 13 it is necessary to understand patients' and clinicians' beliefs and expectations. 14,15 There have been a few small-scale interview studies of sleep management involving clinical specialists 16 and patients, 17 and one study of females with insomnia and their GPs, 18 but there remains limited evidence on how the primary care consultation for sleep problems might be improved, or how sleep assessment and psychosocial interventions could be introduced.…”

Section: Introductionmentioning

confidence: 99%