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Management of Insomnia01:19

Management of Insomnia

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The sleep cycle, an integral part of human health, consists of several stages with distinct characteristics and functions. It begins with a transition from wakefulness to sleep, known as the light sleep phase, followed by the restorative deep sleep phase, essential for physical recovery and growth. The cycle concludes with the Rapid Eye Movement (REM) phase, characterized by high brain activity and vivid dreaming. Insomnia, a prevalent sleep disorder, involves difficulty falling asleep, staying...
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Sedatives and Hypnotics Drugs: Miscellaneous Agents01:17

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Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
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Sedatives are drugs that alleviate anxiety, while hypnotics induce sleep. Both classes of medication suppress neuronal activity, leading to a calming effect for sedatives and facilitating sleep for hypnotics.
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
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Substance Use Disorders Affecting Sleep01:24

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Substance use disorders involve a pattern of using drugs more extensively than intended and continuing use despite harmful consequences. This includes legal substances like alcohol and nicotine, as well as illegal drugs. These disorders often involve both physical and psychological dependence, reflecting compulsive use of substances that significantly alter thoughts, feelings, and behaviors, contributing to a major public health issue.
Understanding the concepts of physical dependence,...
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CNS Depressants: Barbiturates and Benzodiazepines01:14

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CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...
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Medications are typically administered to achieve therapeutic effects. Some drugs can modify an individual's mood and perception, frequently resulting in various enjoyable experiences. However, this can result in drug dependency, a condition marked by continuous drug use despite potential negative consequences. Drug dependency primarily falls into two categories: psychological and physical dependence. Psychological dependence occurs when the pleasurable feelings induced by the drug...
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Updated: May 12, 2025

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A Mechanistic study assessing difficulty discontinuing chronic hypnotic use.

Timothy Roehrs1,2, Gail Koshorek3, Mohammad Sibai3

  • 1Henry Ford Health System, Sleep Disorders and Research Center & Research Ctr Henry Ford Hospital, 2799 West Grand Blvd, CPF-3 Detroit, MI, 48202, USA. troehrs1@hfhs.org.

Psychopharmacology
|May 9, 2025
PubMed
Summary
This summary is machine-generated.

Chronic hypnotic use can be difficult to discontinue, especially for those with hyperarousal. Receptor non-specific hypnotics like eszopiclone may present greater discontinuation challenges than specific ones like zolpidem XR.

Keywords:
Chronic insomniaDiscontinuing hypnotic useEszopicloneZolpidem XR

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Area of Science:

  • Sleep Medicine
  • Pharmacology

Background:

  • Chronic hypnotic use is a clinical concern due to potential abuse liability.
  • Insomnia and hyperarousal are key factors influencing hypnotic discontinuation difficulty.

Purpose of the Study:

  • To compare discontinuation difficulty of chronic hypnotic use in insomnia patients with and without hyperarousal.
  • To assess if receptor non-specific hypnotics (eszopiclone) pose greater discontinuation challenges than receptor-specific hypnotics (zolpidem XR).

Main Methods:

  • 41 adult insomnia patients (23-61 years) without other sleep disorders or comorbidities were randomized to 6 months of zolpidem XR, eszopiclone, or placebo.
  • Following nightly use, participants underwent a 2-week discontinuation period with a self-administration option for their assigned blinded medication.
  • Nocturnal polysomnography (NPSG) was used for screening.

Main Results:

  • 51% of participants successfully discontinued hypnotics, with a median of 3 capsules taken by those who continued use.
  • Insomnia patients with hyperarousal experienced greater difficulty discontinuing hypnotics compared to those without hyperarousal.
  • Patients discontinuing eszopiclone showed more difficulty compared to those discontinuing zolpidem XR or placebo.

Conclusions:

  • Most participants successfully discontinued chronic hypnotic use.
  • Discontinuation difficulty was associated with hyperarousal and the type of hypnotic used (eszopiclone vs. zolpidem XR).
  • Among those who continued use, consumption decreased during the two-week discontinuation period.