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"As Needed" Zolpidem and Behavioral Therapy Safely Treats Chronic Insomnia
A DGReview of :""As Needed" Pharmacotherapy Combined with Stimulus Control Treatment in Chronic Insomnia—Assessment of a Novel Intervention Strategy in a Primary Care Setting"
Annals of Clinical Psychiatry
05/06/2002
By David Loshak
Primary care practitioners can use the hypnotic agent zolpidem "as needed" to treat chronic insomnia.
This approach is safe and effective and can be amended by behavioural therapy in the form of stimulus control, report investigators at the Universities of Dresden, Göttingen and Regensburg, Germany.
The investigators commented that discontinuous, non-nightly hypnotic treatment of chronic insomnia was not only likely to maintain efficacy but would also avoid the risks of tolerance and dependence associated with unnecessary nightly use longterm.
Four earlier studies using zolpidem with increasing flexibility in drug intake schedules had favourable results. This led the investigators to conduct a
prospective, observational open study in 550 German primary care settings of "as needed" zolpidem pharmacotherapy amended by the optional use of stimulus control in conditions close to "real life" practice.
The study included 2,690 patients, mean age 59 years, with chronic insomnia. Two-thirds of the patients were women and half had received pharmacotherapy pre-treatment.
The patients took up to five zolpidem tablets a week for three weeks according to an "as-needed" schedule on nights of their own choice, with optional stimulus control on drug-free nights.
After three weeks, the patients were taking an average 2.6 tablets weekly, 28 percent less than the average 3.7 tablets at baseline. This reduction had no significant impact on treatment efficacy.
The subjective latency to sleep onset fell from a mean of 74.27 minutes and total sleep time increased from 5.0 to 6.8 hours. The investigators rated efficacy of treatment as good or very good in 93 percent of the patients. Adverse events, mostly mild, were observed in 1.2 percent. There were no serious adverse events.
Annals of Clinical Psychiatry 2002;14(1):1-7.
""As Needed" Pharmacotherapy Combined with Stimulus Control Treatment in Chronic Insomnia—Assessment of a Novel Intervention Strategy in a Primary Care Setting"
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