Zolpidem, a valuable alternative to benzodiazepine hypnotics for chronic insomnia?

Sleep quality and anxiety levels were examined using questionnaires and pol ysomnographic recordings in 22 chronic insomnia patients who regularly used benzodiazepines to treat their sleeping problems. After abruptly discontin uing their benzodiazepine medication, patients were randomly allocated to r eceive either a placebo or zolpidem 10 mg for 1 week, after which they ente red an open extension phase, receiving zolpidem 10 mg for 3 weeks. Subjecti vely, sleep quality was considered mediocre during the use of a benzodiazep ine hypnotic. One week after the discontinuation, an increase in sleep late ncy was observed in the placebo group, whereas zolpidem induced a significa nt decrease in sleep latency. Deterioration of other sleep variables (proba bly rebound) was not suppressed by zolpidem. An explanation for this could be the selective pharmacological profile of zolpidem. Polysomnographic diff erences between placebo and benzodiazepine and between placebo and zolpidem were not reflected by the subjective data on sleep and anxiety. Changes of sleep structure caused by hypnotics seem not always to be felt as such by patients. After 3 - 4 weeks of zolpidem treatment, the percentage of non-ra pid eye movement-4 sleep increased significantly, corresponding with a sign ificant subjective improvement of sleep quality. This indicates that zolpid em may restore physiological sleep.