AN ASSESSMENT OF SHORT-ACTING HYPNOTICS

Insomnia, the experience of poor quality or quantity of sleep, is a ve ry common complaint. Approximately 65 million adults (36% of the Ameri can population) complain of poor sleep, and of this group, 25% have in somnia on a chronic basis, These chronic insomniacs not only report hi gher rates of difficulty with concentration, memory and the ability to cope with minor irritations but also have 2.5 times more fatigue-rela ted automobile accidents than do good sleepers, Despite its ubiquity, insomnia is often either untreated or inadequately treated, Short-acti ng hypnotics are advocated for transient insomnia, which fasts less th an 3 weeks, and in patients with chronic insomnia as an adjunctive tre atment where nonpharmacological treatment is not sufficient to allevia te insomnia and the related daytime detrimental effects. The putative adverse effects of hypnotics must be weighed against the severe health effects caused by continued sleep impairment. If hypnotic agents are used, they should be taken nightly only for brief use, or intermittent ly in longer term use. Benzodiazepines, zolpidem and zopiclone (in cou ntries where the latter is available) remain the recommended hypnotic agents, although in the past few years there has been much criticism i n lay magazines and on television about the use of benzodiazepines. Ho wever, this review of the efficacy and tolerability data of the short- acting hypnotics suggests that triazolam is comparable with other shor t-acting hypnotics at equipotent doses while taking into consideration that for every hypnotic, different study populations display differen t degrees of efficacy. In addition, contrary to previous suggestions t hat such adverse effects as rebound insomnia and anterograde amnesia a re unique to triazolam, hypnotically equivalent doses of triazolam hav e not been shown to produce these effects more frequently than other s hort-acting hypnotics, The newer nonbenzodiazepine hypnotics seem to b e equally efficacious as the short-acting benzodiazepines; whether the y will truly have a better adverse effect profile will be determined a s more clinical experience accumulates, Despite the availability, rela tive safety and efficacy of these newer hypnotic agents, they should n ot be perceived as the sole treatment for insomnia and should be used in conjunction with nonpharmacological techniques (such as adherence t o good sleep hygiene, sleep restriction, stimulus control and biofeedb ack therapy).