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Rebound insomnia: a critical review.
J C Gillin1, C L Spinweber, L C Johnson
1Department of Psychiatry, University of California, San Diego.
Journal of Clinical Psychopharmacology
|June 1, 1989
Summary
Discontinuation of short half-life benzodiazepines like triazolam can cause rebound insomnia, a worsening of sleep. Long half-life benzodiazepines, such as flurazepam, pose a lower risk, with temazepam showing minimal rebound effects.
Area of Science:
- Pharmacology
- Sleep Medicine
- Neuroscience
Background:
- Rebound insomnia is a known adverse effect following the cessation of short half-life benzodiazepine hypnotics.
- Understanding the risk profile of different benzodiazepines is crucial for managing insomnia treatment.
Purpose of the Study:
- To review sleep laboratory studies on rebound insomnia after discontinuing triazolam, temazepam, and flurazepam.
- To compare the incidence of rebound insomnia across benzodiazepines with varying half-lives.
Main Methods:
- Systematic review of polygraphically recorded sleep studies and subjective sleep reports.
- Analysis of studies involving insomniac patients, poor sleepers, and normal controls.
- Evaluation of rebound insomnia incidence following different benzodiazepine agents and dosages.
Main Results:
- Rebound insomnia is a significant risk with triazolam, particularly at 0.5 mg, in both insomniacs and normal controls.
- Tapering triazolam dosage attenuated rebound insomnia in subjective sleep reports.
- Temazepam showed a low risk of rebound insomnia, while flurazepam's long half-life delayed but did not eliminate potential mild rebound effects.
Conclusions:
- Short half-life benzodiazepines, especially triazolam, are associated with a higher risk of rebound insomnia.
- Longer half-life benzodiazepines may offer a reduced risk of rebound insomnia.
- Dosage tapering can mitigate rebound insomnia associated with triazolam discontinuation.