What is the efficacy of sedative-hypnotic drugs for the treatment of insomnia?

Updated: Sep 11, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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In the past, most studies of the efficacy of sedative-hypnotics had been short-term trials, generally less than 4 weeks. Use for longer than 4 weeks was thought to result in tolerance and decreased efficacy, although supportive findings are scarce, and the epidemiologic literature suggests that patients report continued efficacy with continued use. Nevertheless, because of the addictive nature of benzodiazepines, most authorities believe that the duration of use of these drugs should be limited.

Studies have indicated, however, that nonbenzodiazepine receptor agonists can have long-term efficacy for 6-12 months without the development of tolerance. Eszopiclone, the first sedative-hypnotic to be tested over a 6-month period, showed continued efficacy with nightly use over that period, with improved quality of life, reduced work limitations, and reduced global insomnia severity. [76, 77] Another study demonstrated continued efficacy at 12 months. [78]

Krystal et al showed long-term efficacy and safety of sustained-release zolpidem (Ambien-CR) for 6 months in a double-blind, placebo-controlled trial. [79] Zolpidem can be used at a dose of 5 or 10 mg at bedtime for sleep-onset insomnia; zolpidem-controlled release can be used at doses of 6.25 or 12.5 mg for patients with sleep-maintenance insomnia or patients with both sleep-onset and sleep-maintenance insomnia.

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