Assessment of hypnotic effects and patient satisfaction in empirical use of sleep medicines

We assessed the hypnotic effects of and patient satisfaction with three types of hypnotics prescribed empirically: ultra-short-acting (US-a), short-acting (S-a), and intermediate- and long-acting (IL-a) agents.

We studied 310 insomniac patients (age 60.5 +/- 15.0 years) treated with US-a (n = 124), S-a (n = 149) or IL-a (n = 37) agents. Patients were interviewed to evaluate individual satisfaction and drug efficacy. Efficacy, as assessed by total sleep time (TST) and sleep latency time (SLT), was compared between satisfied and dissatisfied patient groups. Nocturnal awaking curve for each hypnotic was used for comparing the effects between satisfied and dissatisfied patient groups in each type of hypnotics.

Thirty-two patients (25.8%) were dissatisfied with US-a, 35 (23.5%) with S-a and 11 (29.7%) with IL-a. TST differed significantly between satisfied and dissatisfied groups: 424 +/- 88 vs. 345 +/- 101 min for US-a (P < 0.001), 440 +/- 84 vs. 359 +/- 111 min for S-a (P < 0.001) and 453 +/- 96 vs. 345 +/- 125 min for IL-a (P < 0.01), respectively. With IL-a agents, the SLT of dissatisfied patients was longer than in satisfied ones (81 +/- 52 vs. 33 +/- 22 min, P < 0.05). Twenty (62.5%) dissatisfied patients taking US-a agents awoke before 05:00 hours - a rate significantly higher than satisfied patients (n = 23, 25.0%, P < 0.001). These characteristics of dissatisfied patients were reflected by the patterns of nocturnal awaking curves, although the patterns for satisfied patients were similar among the three types of hypnotics.

Between 24% and 30% of patients were dissatisfied with their hypnotics. Shorter TST was common in dissatisfied patients receiving any agent, for reasons differing among hypnotics (longer SLT with IL-a agents and early awakening with US-a). Drug efficacy and patient satisfaction in empirical use of hypnotics can be assessed by nocturnal awaking curves for each hypnotic.