Hypnotic Discontinuation Using a Blinded (Masked) Tapering Approach: A Case Series.

Area of Science:

• Psychiatry
• Sleep Medicine
• Pharmacology

Background:

• Chronic hypnotic use, including benzodiazepines, is linked to adverse effects like increased fall risk.
• Discontinuing hypnotic medications presents challenges, with varying success rates for current interventions.
• Negative expectancies of withdrawal symptoms can hinder successful hypnotic discontinuation.

Purpose of the Study:

• To assess the feasibility of a blinded tapering protocol for hypnotic medications.
• To evaluate the efficacy of combining blinded tapering with cognitive behavioral therapy for insomnia (CBTI).
• To explore the impact of this combined approach on sleep-related beliefs and insomnia severity.

Main Methods:

• A feasibility study involving 5 adult patients from an outpatient mental health practice.
• Implementation of a blinded (masked) hypnotic tapering protocol, where participants did not know their specific dosage schedule.
• Integration of the blinded taper with supervised hypnotic tapering and CBTI.
• Collection of data on feasibility, hypnotic use, sleep beliefs, insomnia severity, sleepiness, and depressive symptoms.

Main Results:

• The blinded tapering intervention was feasible and participants reported high satisfaction.
• All 5 participants successfully discontinued their hypnotic medication use post-treatment.
• Significant improvements were observed in dysfunctional beliefs/attitudes about sleep and insomnia severity.

Conclusions:

• Blinded tapering is a promising strategy for enhancing hypnotic medication discontinuation.
• Combining blinded tapering with CBTI appears effective in improving sleep outcomes.
• This novel approach warrants further investigation in larger randomized trials.