J Korean Med Assoc.  2015 Sep;58(9):827-832. 10.5124/jkma.2015.58.9.827.

Pros and cons of pharmacotherapy in insomnia

Affiliations
  • 1Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea. leeeun@yuhs.ac

Abstract

The consultation of personnel in relation to sleep disorders in Korea increased by 1.6 times between 2008 and 2012, and the related days of clinical practice increased by nearly 12 times during the same period. Among the sleep disorders, the most common diagnosis is insomnia, which is most commonly treated with medication. Medication is not only easy to access, but also effective immediately. However, the beneficial effect of hypnotic medication on sleep disorder for an extended period of time may be trivial. Tolerance is another barrier to treating chronic insomnia. In addition, such adverse effects as psychomotor slowing, memory loss, forgetfulness, and decreased sense of balance can heighten the risk of motor vehicle accidents and falling-related injuries. Recently, there have been reports about the association between the chronic use of sleeping pills and cancer mortality and dementia incidence. However, there are still many limitations to understanding whether it is the chronic use of hypnotics, or coexisting mental and physical illness, which increases the risk. Nevertheless, it is worthwhile to pay special attention to the abovementioned risks when using hypnotics and to consider alternative treatment options like cognitive behavioral therapy for insomnia.

Keyword

Sleep; Sleep initiation and maintenance disorders; Drug therapy; Practice guideline; Cognitive therapy

MeSH Terms

Cognitive Therapy
Dementia
Diagnosis
Drug Therapy*
Hypnotics and Sedatives
Incidence
Korea
Memory Disorders
Mortality
Motor Vehicles
Sleep Initiation and Maintenance Disorders*
Sleep Wake Disorders
Hypnotics and Sedatives

Reference

1. Zammit GK, Weiner J, Damato N, Sillup GP, McMillan CA. Quality of life in people with insomnia. Sleep. 1999; 22:Suppl 2. S379–S385.
2. Avidan AY. Insomnia in the geriatric patient. Clin Cornerstone. 2003; 5:51–60.
Article
3. Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders: an opportunity for prevention? JAMA. 1989; 262:1479–1484.
Article
4. Vgontzas AN, Liao D, Pejovic S, Calhoun S, Karataraki M, Basta M, Fernandez-Mendoza J, Bixler EO. Insomnia with short sleep duration and mortality: the Penn State cohort. Sleep. 2010; 33:1159–1164.
Article
5. Parthasarathy S, Vasquez MM, Halonen M, Bootzin R, Quan SF, Martinez FD, Guerra S. Persistent insomnia is associated with mortality risk. Am J Med. 2015; 128:268–275.
6. Cho HJ, Lavretsky H, Olmstead R, Levin MJ, Oxman MN, Irwin MR. Sleep disturbance and depression recurrence in community-dwelling older adults: a prospective study. Am J Psychiatry. 2008; 165:1543–1550.
Article
7. Lee E, Cho HJ, Olmstead R, Levin MJ, Oxman MN, Irwin MR. Persistent sleep disturbance: a risk factor for recurrent depression in community-dwelling older adults. Sleep. 2013; 36:1685–1691.
Article
8. National Sleep Foundation. Sleep in America poll [Internet]. Arlington: National Sleep Foundation;2002. cited 2015 Sep 1. Available from: http://sleepfoundation.org/sleep-polls-data/sleep-in-america-poll/2002-adult-sleep-habits.
9. Health Insurance Policy Research Institute. Sleep disorder, 12% annual increase for this 5 years [Internet]. Sejong: Korea Development Institute;2013. cited 2015 Sep 1. Available from: http://www.kdi.re.kr/infor/ep_view.jsp?num=128601.
10. Chong Y, Fryer CD, Gu Q. Prescription sleep aid use among adults: United States, 2005-2010. NCHS Data Brief. 2013; (127):1–8.
11. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008; 4:487–504.
Article
12. Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA. 1999; 281:991–999.
Article
13. Morin CM, Vallieres A, Guay B, Ivers H, Savard J, Merette C, Bastien C, Baillargeon L. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. 2009; 301:2005–2015.
Article
14. Riba J, Rodriguez-Fornells A, Munte TF, Barbanoj MJ. A neurophysiological study of the detrimental effects of alprazolam on human action monitoring. Brain Res Cogn Brain Res. 2005; 25:554–565.
Article
15. Chang CM, Wu EC, Chen CY, Wu KY, Liang HY, Chau YL, Wu CS, Lin KM, Tsai HJ. Psychotropic drugs and risk of motor vehicle accidents: a population-based case-control study. Br J Clin Pharmacol. 2013; 75:1125–1133.
Article
16. Gustavsen I, Bramness JG, Skurtveit S, Engeland A, Neutel I, Morland J. Road traffic accident risk related to prescriptions of the hypnotics zopiclone, zolpidem, flunitrazepam and nitrazepam. Sleep Med. 2008; 9:818–822.
Article
17. Farkas RH, Unger EF, Temple R. Zolpidem and driving impairment: identifying persons at risk. N Engl J Med. 2013; 369:689–691.
Article
18. Kuehn BM. FDA warning: Driving may be impaired the morning following sleeping pill use. JAMA. 2013; 309:645–646.
Article
19. Lai MM, Lin CC, Lin CC, Liu CS, Li TC, Kao CH. Long-term use of zolpidem increases the risk of major injury: a population-based cohort study. Mayo Clin Proc. 2014; 89:589–594.
Article
20. Nzwalo H, Ferreira L, Peralta R, Bentes C. Sleep-related eating disorder secondary to zolpidem. BMJ Case Rep. 2013; 02. 21. [Epub]. DOI: 10.1136/bcr-2012-008003.
Article
21. Auger RR. Sleep-related eating disorders. Psychiatry (Edgmont). 2006; 3:64–70.
22. Jaussent I, Ancelin ML, Berr C, Peres K, Scali J, Besset A, Ritchie K, Dauvilliers Y. Hypnotics and mortality in an elderly general population: a 12-year prospective study. BMC Med. 2013; 11:212.
Article
23. Kripke DF, Langer RD, Kline LE. Hypnotics' association with mortality or cancer: a matched cohort study. BMJ Open. 2012; 2:e000850.
Article
24. Billioti de Gage S, Moride Y, Ducruet T, Kurth T, Verdoux H, Tournier M, Pariente A, Begaud B. Benzodiazepine use and risk of Alzheimer's disease: case-control study. BMJ. 2014; 349:g5205.
Article
25. Shah C, Sharma TR, Kablinger A. Controversies in the use of second generation antipsychotics as sleep agent. Pharmacol Res. 2014; 79:1–8.
Article
26. Sivertsen B, Omvik S, Pallesen S, Bjorvatn B, Havik OE, Kvale G, Nielsen GH, Nordhus IH. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA. 2006; 295:2851–2858.
Article
27. Morin CM. Insomnia: psychological assessment and management. New York: Guilford Press;1993.
28. Bootzin RR, Nicassio P. Behavioral treatments for insomnia. In : Hersen M, Eisler RH, Miller PM, editors. Progress in behavior modification. New York: Academic Press;1978. p. 1–47.
29. Spielman AJ, Saskin P, Thorpy MJ. Treatment of chronic insomnia by restriction of time in bed. Sleep. 1987; 10:45–56.
30. Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. 2004; 164:1888–1896.
Article
31. Ong JC, Kuo TF, Manber R. Who is at risk for dropout from group cognitive-behavior therapy for insomnia? J Psychosom Res. 2008; 64:419–425.
Article
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