Programme no. 144-OP
Successful withdrawal from long-term use of benzodiazepine-type hypnotics is possible in primary care outpatient clinic and improves sleep and quality of life in older people with primary insomnia
Ritva Lähteenmäki*1, T. Vahlberg2, P.J. Neuvonen3, J. Puustinen4, M. Partinen5, I. Räihä6, S-L. Kivelä7
1Family Medicine,Univ. of Turku,Turku,Finland, 2Biostatistics,Univ. of Turku,Turku,Finland, 3Clinical Pharmacology,University of Helsinki,Helsinki,Finland, 4Neurology,Satakunta Central Hospital,Pori,Finland, 5Neurology,University of Helsinki,Helsinki,Finland, 6Family Medicine,Univ. of Turku,Turku,Finland, 7Family Medicine,Satakunta Central Hospital,Pori,Finland
* = Presenting author
Objectives: Our aim was to study the effect of withdrawal from the long-term use of BDZs on perceived sleep and quality of life in older outpatients with primary insomnia
Background: Primary insomnia is often associated with the chronic use of benzodiazepine-type hypnotics (here BZD). Tolerance and dependence develop easily, and BZDs increase the risk of fractures and dementia.
Results: 89 participants (97%) completed the 6 months follow-up. At month 6, 34 of the participants were total withdrawers (TWs) and 55 continued or only reduced their BZDs (NWs). The sleep onset latency was similar in both groups at baseline but at 6 months it was shorter in TWs than in NWs (P=0.017), and TWs didn’t need additional medicine at nightly awakenings (P<0.0001 compared to baseline; P=0.034 compared to NWs). Also NWs reduced their use of nightly additional medicines, COR 2.70 (1.42-5.15; P=0.0025 vs. baseline). Compared to baseline, fatigue during days alleviated in TWs (P=0.0002) but not in NWs. Quality of life was better in TWs than in NWs (P=0.036) at months 1 and 6, and stress was decreased in TWs more than in NW (P=0.039). In TWs stress was abated already at month 1 compared to the baseline, by COR 2.49 (1.46-4.24)(P=0.0008). Satisfaction with life and self-reported health were recuperated in TWs at month 6.
Material/Methods: Double-blind, RCT was performed in a primary care clinic (Pori). 92 men or women (≥55 years) with primary insomnia, chronic temazepam, zopiclone or zolpidem use and willingness to withdraw their BZDs received either melatonin (2 mg) or placebo nightly for one month, during which BZDs were aimed to be gradually withdrawn. A primary care physician and nurse gave individual sleep hygiene counselling and psychosocial support. Melatonin did not improve withdrawal results over placebo. Different parameters of sleep and quality of life were studied using a questionnaire at baseline (before withdrawal), and 1 and 6 months later.
Conclusion: Chronic BZD-users suffered from sleep disturbances, day-time fatigue, and impaired quality of life, which were reversible within 6 months of successful BZD withdrawal. Withdrawal of chronic use of BZDs as hypnotics is possible also in primary care and improves quality of life in older people with primary insomnia. Psychosocial support should be combined to gradual dose reduction of BZDs, and melatonin or placebo may be of benefit.
Points for discussion: 1. Have you seen hypnotic dependent older people in your practice? 2. Have you tried to withdraw chronic BZD-users?