[Sleep disorders and hypnotic agents: medical, social and economical impact]

Insomnia is a subjective complaint relating to approximately 30% of the adult population in France, described by the patient as a difficulty of initiating and/or maintaining sleep. Its prevalence increases with age and sex: women are more affected than men (24% vs 14%). Insomnia is either occasional (20%), or chronic (10%). Chronic insomnia has an important impact on patients' everyday life e.g. fatigue, perturbed diurnal waking state, impaired quality-of-life... which results in lower work productivity and drowsiness as well as relational difficulties, absenteeism. About 80% of patients consult their general practitioner first. The aim of a hypnotic agent is to obtain sleep as physiological as possible. Benzodiazepines and benzodiazepines-like agents (zopiclone, zolpidem, zaleplon) are the most widely used hypnotics. However, their indications must be limited to occasional insomnia with a limited duration: less than four weeks. There is no advantage with using a combination of hypnotic agents, a practice which should be prohibited. Adverse effects can be serious, e.g. diurnal somnolence associated with risks of road accidents and, in the elderly, the risk of falls. After chronic use, hypnotics can be addictive, as their effects wear off in three to four weeks. After withdrawal, insomnia rebound is frequent. Use of hypnotics in association with alcohol is a well-known drug-addiction behavior. According to the French health insurance fund, 9% of the general population use hypnotics and about half of them regularly. Insurance refunds for hypnotics and sedatives reach more than 110 million euros annually. The efficiency of hypnotics wears off, quickly for benzodiazepines (three - four weeks), or less quickly for zopiclone and zolpidem (a few months). Insomnia is a major public health issue, each year 10% of the incident cases of insomnia treated by hypnotics joint the group of subjects with chronic insomnia. This failure to treat insomnia properly can be explained, at least in part, by several insufficiencies: physicians and pharmacists training, medical profession awareness, research, public information on the rules of good sleep (public health campaigns, booklets, role of physicians and the pharmacists).