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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by fachad on April 1, 2002, at 8:32:33
Dr. Kramer:
My question is about the apparent discrepancy between theory and practice regarding the long term usage of benzodiazapine hypnotics for insomnia.
Anywhere I find written references in the literature, whether it be journals or textbooks, there is strong verbiage that does not leave much room for interpretation. The consensus is that hypnotics should not be prescribed for more than a few days, or a few weeks maximum.
Yet in the reality of the everyday practice of both GPs and Psychiatrists it seems extremely common for BZ hypnotics to be used very long term, sometimes indefinitely.
The other oddball in this whole mystery is Ambien. It too has a general recommendation for short-term use, but there are scattered written references to Ambien being acceptable for longer-term usage in some situations. Since it acts on the BZ receptor, shouldn’t the same restrictions that apply to the classical benzodiazapines apply to Ambien?
This issue is of personal concern to me because I have (amongst other things) chronic insomnia. I don't like Ambien because it's expensive, and it wears off too quickly, actually worsening my early morning awakenings.
My current psychiatrist is fine with me taking Ativan, but I just wonder why there is this huge incongruence in medicine between explicitly stated consensus positions against long term hypnotic usage, and the actual prescribing patterns of physicians who frequently do prescribe benzodiazapine hypnotics long term.
Any comments?
Posted by fachad on April 1, 2002, at 10:02:18
In reply to Kramer - Long Term Use of Benzos for Insomnia, posted by fachad on April 1, 2002, at 8:32:33
Just a clarification and some assumptions to proceed with for my question.
Just for the sake of discussion, please assume a few things, which for the most part, are true in my case:
1.) I have diligently and exhaustively tried non-BZ hypnotics like trazodone, TCAs, etc, and found them to be either ineffective or intolerable or both.
2.) I am cognizant of sleep hygiene techniques and am not contributing to my insomnia by poor sleep hygiene or other behavioral factors.
3.) All of my other underlying psychiatric disorders have been aggressively treated and are in full or nearly full remission.
4.) Despite #1, #2, and #3, my insomnia is persistent.
I just didn't want to take up your time going over ground I've already been over. The question was more philosophical than practical anyway.
Posted by Dr. Kramer on April 1, 2002, at 20:50:54
In reply to Re: Kramer - Assumptions for Above Question, posted by fachad on April 1, 2002, at 10:02:18
Understood. I think your condition is fairly common.
I'm no sleep doc, but friends of mine who are say that when they get these folks in the sleep lab, their physiologic sleep patterens are disrupted, and the basic rule of thumb is that it takes the same amout of time (years) that they were on long acting benzos to normalize the sleep patterns drug free.
I like Ambien (and Sonata) because they are not true benzos (they bind to GABA receptors somewhat differently) but may be more benign in this regard. This is certainly not established, just a possibility. They do last A LOT LESS time, and if you need a longer acting med, they're not for you. If you sleep well now, then you've accomplished what you set out to do. Benzos are wonderful, safe, and effective drugs.
This is the end of the thread.
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