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Withdrawal from long-term use of zopiclone, zolpidem and temazepam may improve perceived sleep and quality of life in older adults with primary insomnia.
Basic Clin Pharmacol Toxicol 2019; 124(3):330-340BC

Abstract

Long-term use of benzodiazepines or benzodiazepine receptor agonists is widespread, although guidelines recommend short-term use. Only few controlled studies have characterized the effect of discontinuation of their chronic use on sleep and quality of life. We studied perceived sleep and quality of life in 92 older (age 55-91 years) outpatients with primary insomnia before and after withdrawal from long-term use of zopiclone, zolpidem or temazepam (BZDA). BZDA was withdrawn during 1 month, during which the participants received psychosocial support and blindly melatonin or placebo. A questionnaire was used to study perceived sleep and quality of life before withdrawal, and 1 month and 6 months later. 89 participants completed the 6-month follow-up. As melatonin did not improve withdrawal, all participants were pooled and then separated based solely on the withdrawal results at 6 months (34 Withdrawers. 55 Nonwithdrawers) for this secondary analysis. At 6 months, the Withdrawers had significantly (P < 0.05) shorter sleep-onset latency and less difficulty in initiating sleep than at baseline and when compared to Nonwithdrawers. Compared to baseline, both Withdrawers and Nonwithdrawers had at 6 months significantly (P < 0.05) less fatigue during the morning and daytime. Stress was alleviated more in Withdrawers than in Nonwithdrawers (P < 0.05). Satisfaction with life and expected health 1 year later improved (P < 0.05) in Withdrawers. In conclusion, sleep disturbances, daytime fatigue and impaired quality of life may resolve within 6 months of BZDA withdrawal. These results encourage withdrawal from chronic use of benzodiazepine-type hypnotics, particularly in older subjects.

Authors+Show Affiliations

Department of Family Medicine, University of Turku, Turku, Finland.Department of Clinical Pharmacology, University of Helsinki, and HUSLAB, Helsinki University Hospital, Helsinki, Finland.Unit of Neurology, Satakunta Hospital District, Pori, Finland. Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Helsinki, Finland.Department of Biostatistics, University of Turku, Turku, Finland.Helsinki Sleep Clinic, Vitalmed Research Center, Helsinki, Finland. Department of Neurology, University of Helsinki, Helsinki, Finland.Department of Family Medicine, University of Turku, Turku, Finland.Department of Family Medicine, University of Turku, Turku, Finland. Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Helsinki, Finland.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

30295409

Citation

Lähteenmäki, Ritva, et al. "Withdrawal From Long-term Use of Zopiclone, Zolpidem and Temazepam May Improve Perceived Sleep and Quality of Life in Older Adults With Primary Insomnia." Basic & Clinical Pharmacology & Toxicology, vol. 124, no. 3, 2019, pp. 330-340.
Lähteenmäki R, Neuvonen PJ, Puustinen J, et al. Withdrawal from long-term use of zopiclone, zolpidem and temazepam may improve perceived sleep and quality of life in older adults with primary insomnia. Basic Clin Pharmacol Toxicol. 2019;124(3):330-340.
Lähteenmäki, R., Neuvonen, P. J., Puustinen, J., Vahlberg, T., Partinen, M., Räihä, I., & Kivelä, S. L. (2019). Withdrawal from long-term use of zopiclone, zolpidem and temazepam may improve perceived sleep and quality of life in older adults with primary insomnia. Basic & Clinical Pharmacology & Toxicology, 124(3), pp. 330-340. doi:10.1111/bcpt.13144.
Lähteenmäki R, et al. Withdrawal From Long-term Use of Zopiclone, Zolpidem and Temazepam May Improve Perceived Sleep and Quality of Life in Older Adults With Primary Insomnia. Basic Clin Pharmacol Toxicol. 2019;124(3):330-340. PubMed PMID: 30295409.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Withdrawal from long-term use of zopiclone, zolpidem and temazepam may improve perceived sleep and quality of life in older adults with primary insomnia. AU - Lähteenmäki,Ritva, AU - Neuvonen,Pertti J, AU - Puustinen,Juha, AU - Vahlberg,Tero, AU - Partinen,Markku, AU - Räihä,Ismo, AU - Kivelä,Sirkka-Liisa, Y1 - 2018/12/03/ PY - 2018/06/21/received PY - 2018/09/24/accepted PY - 2018/10/9/pubmed PY - 2019/7/6/medline PY - 2018/10/9/entrez KW - Z-drugs KW - benzodiazepine agonists KW - older outpatients KW - perceived sleep KW - primary insomnia KW - quality of life KW - withdrawal from chronic use SP - 330 EP - 340 JF - Basic & clinical pharmacology & toxicology JO - Basic Clin. Pharmacol. Toxicol. VL - 124 IS - 3 N2 - Long-term use of benzodiazepines or benzodiazepine receptor agonists is widespread, although guidelines recommend short-term use. Only few controlled studies have characterized the effect of discontinuation of their chronic use on sleep and quality of life. We studied perceived sleep and quality of life in 92 older (age 55-91 years) outpatients with primary insomnia before and after withdrawal from long-term use of zopiclone, zolpidem or temazepam (BZDA). BZDA was withdrawn during 1 month, during which the participants received psychosocial support and blindly melatonin or placebo. A questionnaire was used to study perceived sleep and quality of life before withdrawal, and 1 month and 6 months later. 89 participants completed the 6-month follow-up. As melatonin did not improve withdrawal, all participants were pooled and then separated based solely on the withdrawal results at 6 months (34 Withdrawers. 55 Nonwithdrawers) for this secondary analysis. At 6 months, the Withdrawers had significantly (P < 0.05) shorter sleep-onset latency and less difficulty in initiating sleep than at baseline and when compared to Nonwithdrawers. Compared to baseline, both Withdrawers and Nonwithdrawers had at 6 months significantly (P < 0.05) less fatigue during the morning and daytime. Stress was alleviated more in Withdrawers than in Nonwithdrawers (P < 0.05). Satisfaction with life and expected health 1 year later improved (P < 0.05) in Withdrawers. In conclusion, sleep disturbances, daytime fatigue and impaired quality of life may resolve within 6 months of BZDA withdrawal. These results encourage withdrawal from chronic use of benzodiazepine-type hypnotics, particularly in older subjects. SN - 1742-7843 UR - https://www.unboundmedicine.com/medline/citation/30295409/Withdrawal_from_long_term_use_of_zopiclone_zolpidem_and_temazepam_may_improve_perceived_sleep_and_quality_of_life_in_older_adults_with_primary_insomnia_ L2 - https://doi.org/10.1111/bcpt.13144 DB - PRIME DP - Unbound Medicine ER -