The use of lorazepam TID for chronic insomnia

Patients with primary insomnia typically complain of daytime fatigue and st ress and have been shown to have long latencies on the Multiple Sleep Laten cy Test and increased whole body metabolism. However, typical treatment str ategies for patients with insomnia rarely include any component to deal wit h these daytime symptoms. In the present study it was hypothesized that a 2 4-h treatment, lorazepam 0.5 mg TID, would be superior to an evening treatm ent, lorazepam 1.5 mg HS, in patients with primary insomnia. In a repeated measures crossover design, 12 patients with chronic insomnia received place bo or lorazepam 0.5 mg TID in one 4-night lab stay and placebo or lorazepam 1.5 mg HS in another lab stay. Both doses of medication were effective in improving objective and subjective measures of sleep and in reducing noctur nal whole body metabolic rate. Latencies on daytime nap testing were signif icantly reduced from a 14-min average to an average of 10 and 12 min, respe ctively, in the lorazepam 0.5 and 1.5 mg conditions. Significant difference s were not found on psychomotor performance. Subjective reports of anxiety and confusion were increased in the morning after receiving lorazepam 0.5 m g in the evening but tension was reduced and subjective alertness was impro ved in the evening after daytime administration of lorazepam 0.5 mg. It was concluded that measurement and treatment of daytime symptoms is appropriat e in patients with chronic insomnia but that rebounds in anxiety near the e nd of metabolic activity of lorazepam may make it a poor treatment choice. Int Clin Psychopharmacol 14:81-89 (C) 1999 Lippincott Williams & Wilkins.