Can a rapidly-eliminated hypnotic cause daytime anxiety?

Area of Science:

• Pharmacology
• Clinical Psychology
• Sleep Medicine

Background:

• Preliminary reports suggested a link between rapidly eliminated hypnotics and daytime anxiety.
• Poor sleepers often seek pharmacological interventions for sleep disturbances.
• Understanding the side effect profiles of different hypnotics is crucial for patient safety.

Purpose of the Study:

• To investigate whether regular use of a rapidly eliminated hypnotic (triazolam) causes daytime anxiety.
• To compare the effects of triazolam and lormetazepam on sleep and daytime anxiety.
• To evaluate the safety and tolerability of short-term hypnotic use in poor sleepers.

Main Methods:

• A randomized controlled trial involving 120 poor sleepers (82 women, 38 men, mean age 53).
• Participants received triazolam 0.5 mg, lormetazepam 2 mg, or placebo capsules nightly for 45 nights (25 active treatment nights).
• Outcomes assessed included self-rated anxiety, observer-rated response, patient complaints, and weight changes.

Main Results:

• Both triazolam and lormetazepam improved sleep compared to placebo.
• Triazolam users reported significantly higher daytime anxiety, distress, and experienced more adverse events, including weight loss.
• Adverse effects in the triazolam group included panic, depression, derealization, and paranoia after approximately 10 days of use.

Conclusions:

• Regular use of triazolam is associated with increased daytime anxiety and psychological distress in poor sleepers.
• The rapid elimination of triazolam may contribute to daytime withdrawal symptoms and adverse psychological effects.
• Lormetazepam appears to be a safer alternative regarding daytime anxiety compared to triazolam.