A Mechanistic study assessing difficulty discontinuing chronic hypnotic use

The abuse liability of chronic hypnotic use remains a clinical concern.

This study assessed 1) whether there would be greater difficulty discontinuing chronic hypnotic use for people with insomnia and hyperarousal vs those with insomnia but without hyperarousal and 2) whether those seeking to discontinue chronic hypnotic use of the receptor non-specific hypnotic eszopiclone would have more difficulty than those discontinuing the receptor specific zolpidem XR.

DSM-V diagnosed insomnia participants, aged 23-61 yrs, (n = 41, 36 females), with no other sleep disorders, unstable medical or psychiatric diseases or drug dependency completed the trial. Following a screening nocturnal polysomnogram (NPSG) participants were randomized to zolpidem XR (12.5 mg), eszopiclone (3 mg), or placebo nightly for 6 months. After 6 months nightly use, over a 2-week discontinuation, they were instructed to discontinue their hypnotic use, but, if necessary, to self-administer before sleep either 1, 2, or 3 capsules, each packaged separately in envelopes labeled 1, 2, and 3, containing their assigned "blinded" medication or placebo.

Over the 14 nights 21 participants took zero (51%) capsules and among the 20 taking capsules the median total number chosen was 3. Those people with insomnia and hyperarousal vs those with insomnia but not hyperarousal had more difficulty discontinuing chronic hypnotic use (aim 1) as did those using eszopiclone vs zolpidem or placebo (aim 2).

Most subjects discontinued hypnotic use and among the few continuing to use their use declined from week one to week two of the discontinuation period.