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Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the past 18 months, there has been considerable controversy regarding the benzodiazepine triazolam (Halcion). To review data supporting or not supporting the assertion that treatment with triazolam results in adverse reactions more frequently than with other benzodiazepines, the author used computerized literature searches (MEDLINE, English language articles from 1975 to the present) to identify reports of behavioral disinhibition, amnesia, delirium, rebound insomnia, and withdrawal reactions on benzodiazepines. Studies of disinhibitory reactions during benzodiazepine treatment do not substantiate the argument that they are more prevalent with triazolam than with other benzodiazepines. The behavioral disinhibition reactions during treatment with benzodiazepines are associated with higher dosages and pretreatment level of hostility. Anterograde amnesia occurs with many benzodiazepines, but usually without changes in a person's normal activities and behaviors. The reports of anterograde amnesia during benzodiazepine treatment describe people performing rather complex tasks during which outside observers could not detect any unusual behaviors. The prevalence of delirium during treatment with triazolam and other benzodiazepines is unclear, but delirium is more frequent at higher dosages and in the elderly. Controlled studies regarding the adverse effects of triazolam on sleep are lacking. The author concludes that despite the considerable adverse publicity in the lay press, there is little scientific evidence that triazolam is associated with disinhibitory or other adverse reactions at a greater frequency than other benzodiazepines.
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PMID:Disinhibition, amnestic reactions, and other adverse reactions secondary to triazolam: a review of the literature. 148 83

In selecting a hypnotic for the symptomatic management of insomnia, clinicians should look for those that most favorably balance sleep induction and sleep maintenance with potential adverse side effects. While all benzodiazepines have demonstrated efficacy in nocturnal sedation, the side effects of different compounds--and different doses of the same compound--vary greatly. The most common adverse effects associated with benzodiazepines are residual sedation, anterograde amnesia, and rebound insomnia, which are also related to the insomnia complaint itself. Therefore, careful evaluation of the dose of a benzodiazepine hypnotic is the key to effective treatment of insomnia without inducement of adverse effects. The most common side effects of hypnotics and their relation to drug dose are reviewed.
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PMID:Issues in the use of benzodiazepine therapy. 161 14

The most common adverse effects associated with the use of benzodiazepine hypnotics are residual daytime effects (daytime sedation and daytime performance decrements), anterograde amnesia, and rebound insomnia. Studies show that these adverse effects are related to dose. Hence, benzodiazepine hypnotics should be used in low doses so as to minimize or prevent these common adverse effects. It is now generally accepted that benzodiazepines should not be administered long-term for the treatment of chronic "idiopathic" insomnia. Two noncontinuous sleep disturbances, insomnia in the elderly and transient insomnia in young and middle-aged adults, are probably the most acceptable indications for the use of benzodiazepines. Low doses of short- and intermediate-acting benzodiazepines (triazolam and temazepam) are efficacious in the treatment of insomnia in the elderly, and preliminary evidence suggests that they are efficacious in the treatment of transient insomnia in young and middle-aged adults.
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PMID:Clinical uses and advantages of low doses of benzodiazepine hypnotics. 161 15

The abuse liability of a drug is a positive, interactive function of the reinforcing and adverse effects of the drug. The relative abuse liability of the hypnotic benzodiazepine, triazolam, has been controversial. This paper reviews animal and human studies bearing on its relative abuse liability, including data on pharmacological profile, reinforcing effects, liking, speed of onset, discriminative stimulus effects, subjective effects, physiological dependence, rebound and early morning insomnia, drug produced anxiety, lethality in overdose, psychomotor impairment, interactions with ethanol, anterograde amnesia, impaired awareness of drug effect, and other psychiatric and behavioral disturbances. It is concluded that the abuse liability of triazolam is less than that of the intermediate duration barbiturates such as pentobarbital. Although there are considerable data indicating similarities of triazolam to other benzodiazepines, there is also substantial speculation among clinical investigators and some limited data suggesting that the abuse liability of triazolam is greater than that of a variety of other benzodiazepines, and virtually no credible data or speculation that it is less. Further research will be necessary to clarify definitively the abuse liability of triazolam relative to other benzodiazepines.
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PMID:Relative abuse liability of triazolam: experimental assessment in animals and humans. 285 78

Benzodiazepines currently represent the most widely prescribed family of hypnotic drugs. They possess obvious advantages: actual hypnotic efficacy, at least with short-term use, low toxicity, and excellent tolerance. However, several side effects need to be mentioned: besides morning drowsiness (which represents the untoward continuation of their sedative properties), anterograde amnesia, increase of daytime anxiety, and rebound insomnia. Moreover, benzodiazepines significantly modify several sleep parameters: they decrease slow wave sleep and delay the first period of REM sleep. Any hypnotic benzodiazepine should only be prescribed in case of actual need and after exclusion of non-pharmacologic means. The "softest" agent, at the lowest dose, and during the shortest period should always be preferred.
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PMID:[Benzodiazepines and sleep]. 286 71

Lorazepam, 4 mg, was evaluated in an 18-night sleep-laboratory study involving five insomniac subjects. Hypnotic effectiveness and effects on sleep stages and related parameters were assessed. Placebo was given on baseline nights 1 to 4, lorazepam on nights 5 to 11, and placebo was given again on withdrawal nights 12 to 18. Subjective and objective data clearly demonstrated that lorazepam was effective for both inducing and maintaining sleep. Sleep latency was reduced from a baseline value of 34.6 min to 17.9 min (P less than 0.01) and total wake time was reduced from 75.9 to 38.5 min (P less than 0.01). On the third and fifth nights of drug withdrawal total wake time rose above baseline levels (termed rebound insomnia) and sleep latency increased by 77% and 60% over baseline (P less than 0.01). Subjective estimates of daytime anxiety also increased above baseline (rebound anxiety) during the withdrawal period. All subjects experienced severe hangover and varying degrees of impaired functioning during the first 3 days on drug. Three subjects also experienced anterograde amnesia during the day after the first drug night. These side effects diminished in intensity over the course of the study. Our results suggest that while 4 mg lorazepam may be effective in inducing and maintaining sleep, this dose induces clinically significant side effects that are followed by consistent rebound phenomena after withdrawal.
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PMID:Lorazepam-efficacy, side effects, and rebound phenomena. 612 58

We studied in a sleep laboratory the effects of bedtime 15 mg midazolam and 20 mg midazolam on the sleep and morning performance of healthy subjects with polygraphically verified sleep onset insomnia. Six subjects received 15 mg midazolam and six subjects received 20 mg midazolam for 14 consecutive nights which were preceded by a three-night placebo baseline and followed by a three-night placebo period. The medications were administered in a double-blind manner. The results were that both doses increased total sleep time, reduced sleep latency, reduced wake time after sleep onset and reduced the number of awakenings. There was no difference between the doses. Midazolam had its main effect by decreasing wake time in the first third of the night. We found no evidence of tolerance, drug withdrawal rebound insomnia, or drug-induced morning performance decrements. We did find evidence of an anterograde amnesia produced by the drug.
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PMID:Effect of midazolam on sleep of insomniacs. 613 60

To critically assess and summarize the beneficial effects of benzodiazepine therapy for insomnia in community-dwelling elders, a systematic search was undertaken to review all published clinical trials and sleep laboratory studies. The risk of injury for benzodiazepine users was also reviewed. Ten studies met inclusion criteria for assessing benefit. There are no studies regarding the long-term effectiveness of benzodiazepines for the treatment of sleep disorders in the elderly. In the sleep laboratory setting, triazolam 0.125 mg, flurazepam 15 mg, and estazolam 1 mg improved sleep latency by 27 to 30 minutes and increased total sleep time by 47 to 81 minutes for the first 2 to 3 nights of treatment, compared with baseline measurements taken while the patients were receiving placebo. In contrast to these modest short-term benefits, there is an association between the use of benzodiazepines with a long half-life, eg, flurazepam, diazepam, and chlordiazepoxide, and an increased risk of hip fracture in the elderly. Triazolam can cause rebound insomnia as well as anterograde amnesia. Clinicians should discontinue their prescribing of long-acting benzodiazepines for elderly patients with insomnia. More research is needed on the effects of nondrug interventions as well as on short- and intermediate-acting benzodiazepines, such as oxazepam and temazepam, to treat insomnia in community-dwelling elderly.
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PMID:Benzodiazepines for insomnia in community-dwelling elderly: a review of benefit and risk. 759 66

Insomnia is a widespread condition which affects approximately one-third of the general population. It is especially prevalent in the elderly. The treatment modalities of insomnia are varied and include nonpharmacological and pharmacological techniques. Insomnia is a symptom of an underlying condition. Before starting treatment, it is imperative to carefully assess the possible causes of insomnia, since the aetiology of the insomnia determines the treatment. Pharmacotherapy is indicated in transient insomnia which occurs in otherwise healthy, normal sleepers, and in the treatment of intermittent insomnia in the elderly. Pharmacotherapy is not indicated in chronic insomnia, except perhaps on an intermittent basis and as adjunctive treatment. If adjunctive pharmacotherapy is to be used in chronic insomnia, the possibility of a primary sleep disorder must be ruled out prior to the use of a sedative hypnotic. When using sedative hypnotic agents, the lowest possible dose should be used for the shortest possible time. Special care should be exercised when treating the elderly, because altered pharmacokinetics in this age group may impair tolerability. Benzodiazepines remain the recommended hypnotic agents, although newer, non-benzodiazepine agents may also be utilised. Despite the relative safety of benzodiazepines, the most common adverse effects include residual daytime sleepiness, rebound insomnia and anterograde amnesia. Short-acting benzodiazepines are more commonly associated with rebound insomnia and withdrawal symptoms, whereas the long acting benzodiazepines are more likely to produce residual daytime sleepiness. Anterograde amnesia may be seen with all benzodiazepines. Use of alcohol for its sedative properties, and over-the-counter preparations, are not recommended for the treatment of insomnia.
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PMID:Pharmacological treatment of insomnia. 768 Sep 84

Insomnia, the experience of poor quality or quantity of sleep, is a very common complaint. Approximately 65 million adults (36% of the American population) complain of poor sleep, and of this group, 25% have insomnia on a chronic basis. These chronic insomniacs not only report higher rates of difficulty with concentration, memory and the ability to cope with minor irritations but also have 2.5 times more fatigue-related automobile accidents than do good sleepers. Despite its ubiquity, insomnia is often either untreated or inadequately treated. Short-acting hypnotics are advocated for transient insomnia, which lasts less than 3 weeks, and in patients with chronic insomnia as an adjunctive treatment where nonpharmacological treatment is not sufficient to alleviate insomnia and the related daytime detrimental effects. The putative adverse effects of hypnotics must be weighted against the severe health effects caused by continued sleep impairment. If hypnotic agents are used, they should be taken nightly only for brief use, or intermittently in longer term use. Benzodiazepines, zolpidem and zopiclone (in countries where the latter is available) remain the recommended hypnotic agents, although in the past few years there has been much criticism in lay magazines and on television about the use of benzodiazepines. However, this review of the efficacy and tolerability data of the short-acting hypnotics suggests that triazolam is comparable with other short-acting hypnotics at equipotent doses while taking into consideration that for every hypnotic, different study populations display different degrees of efficacy. In addition, contrary to previous suggestions that such adverse effects are rebound insomnia and anterograde amnesia are unique to triazolam, hypnotically equivalent doses of tirazolam have not been shown to produce these effects more frequently than other short-acting hypnotics. The newer nonbenzodiazepine hypnotics seem to be equally efficacious as the short-acting benzodiazepines; whether they will truly have a better adverse effect profile will be determined as more clinical experience accumulates. Despite the availability, relative safety and efficacy of these newer hypnotic agents, they should not be perceived as the sole treatment for insomnia and should be used in conjunction with nonpharmacological techniques (such as adherence to good sleep hygiene, sleep restriction, stimulus control and biofeedback therapy).
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PMID:An assessment of short-acting hypnotics. 857 98


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