Therapy can put insomniacs' drug habit to rest

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Therapy can put insomniacs' drug habit to rest

Last Updated: 2004-03-19 13:42:34 -0400 (Reuters Health)

By Amy Norton

NEW YORK (Reuters Health) - Even people who have been taking drugs for

insomnia for years can be weaned off of them without significant

withdrawal symptoms, a new study shows.

Canadian researchers found that most of the 76 older adults they studied

were able to stop using benzodiazepines with the help of supervised

medication " tapering " and psychological therapy to address their

insomnia.

Benzodiazepine drugs have a sedating effect on the central nervous

system and are used to treat a number of conditions, including anxiety

and insomnia. Prescribing guidelines say the drugs should be used for

insomnia for no more than a few weeks because of potential side effects,

including tolerance to the drugs' effects, and dependence.

Despite the guidelines, many people with chronic insomnia--particularly

older adults--take the drugs for years. Some doctors keep prescribing

them because their patients ask for them, according to lead study author

Dr. M. Morin of Universite Laval in Quebec.

Patients can become caught in a " vicious cycle, " he told Reuters Health,

as their benzodiazepines do not relieve their insomnia, yet if they try

to quit " cold turkey, " their sleep problems become worse. And all the

while the underlying cause of their sleepless nights is not addressed.

Patients in Morin's study, all age 55 or older, had been on

benzodiazepines for an average of 19 years.

Despite such prolonged use, however, nearly two thirds were drug-free

within an average of seven weeks of discontinuation therapy, Morin and

his colleagues report in the American Journal of Psychiatry.

The study patients underwent one of three therapy approaches. Some were

treated with medication tapering, where doctors gradually lowered their

benzodiazepine doses, with the goal of cutting out the drugs in 10

weeks.

Others went through 10 weeks of cognitive behavioral therapy, which

aimed to change the way patients' thought about sleep, insomnia and

drug-withdrawal symptoms. The therapy also gave them tactics to battle

their sleep problems--such as using their beds only for sleep and sex,

getting out of bed if they couldn't fall asleep within about 15 minutes,

and getting up at the same time every morning.

A third group of patients received both medication tapering and

cognitive behavioral therapy.

While all three treatment tactics helped most patients eliminate or cut

back on their medication, the combined approach worked best, according

to the researchers.

After 10 weeks of treatment, 85 percent of men and women in the

combined-therapy group were drug-free, compared with 48 percent of those

who received medication tapering and 54 percent in the cognitive

behavioral therapy group.

One year later, 60 percent of patients overall were still off of

benzodiazepines, with the combined-therapy group still showing better

results--though the difference was less marked.

What's more, the researchers say, patients reported few withdrawal

symptoms, such as anxiety and " rebound " insomnia--two major side effects

of abruptly stopping benzodiazepines.

Instead, those who received cognitive behavioral therapy generally had

modest sleep improvements during therapy that became more significant

over the long-term. Patients treated with only medication tapering

showed long-term improvements in sleep.

Morin said that some long-time benzodiazepine users may do well with

only medication tapering, but others may also need the help of a sleep

specialist. He believes that the better results in the combined-therapy

group reflect the ability of cognitive behavioral therapy to get at the

roots of patients' insomnia.

SOURCE: American Journal of Psychiatry, February 2004.

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Mayo Clinic in Rochester

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s Hopkins Medicine

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