Gary K. Zammit, PhD, and Jeffrey A. Kramer, PharmD
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Background: Insomnia is a prevalent
medical disorder that has significant effects on occupational
performance, health, and quality of life. Insomnia places an
enormous burden on society through increased visits to
physicians, loss of productivity in the workplace, and an
increased rate of accidents. An estimated sum of $100 million is
spent each year on direct treatment of unresolved insomnia.
Physicians need to initiate early effective treatment to prevent
development of chronic insomnia and its associated morbidity.
Institution of good sleep hygiene practices may be useful in some
patients but may not be adequate for resolution of all sleep
problems. Behavioral treatments, while effective and durable, are
time consuming and not widely utilized in clinical practice.
Pharmacotherapy includes benzodiazepine hypnotics, but concerns
regarding adverse effects (e.g., residual sedation) prompted the
search for safer options.
Data Sources: Published and presented
studies containing clinical data on zaleplon, a new
nonbenzodiazepine sleep medication, were identified via MEDLINE,
Current Contents (ISI database), bibliographic reviews, and
consultation with sleep specialists.
Results: Zaleplon effectively shortens
sleep onset time and improves the quality of sleep in patients
with insomnia. Whether administered at bedtime or later at night,
zaleplon is devoid of residual sedative effects that impair
next-day functioning. Follow-up studies evaluating the long-term
efficacy and safety of zaleplon showed that decreased time to
sleep onset was maintained during therapy lasting up to 52 weeks,
without a withdrawal syndrome after discontinuation.
Conclusion: Insomnia is recurrent and
unpredictable in nature. Despite the long-term morbidity of this
sleep disorder, research evidence and practice guidelines have
not explored long-term use of hypnotics. Many patients could
benefit from long-term drug therapy with a sleep medication that
is devoid of residual effects and can be taken at bedtime or
later as symptoms occur, rather than nightly in anticipation of a
sleep problem.
Prim Care Companion J Clin Psychiatry 2001;3(2):53-60
https://doi.org/10.4088/PCC.v03n0202
© Copyright 2001 Physicians Postgraduate Press, Inc.