0462 Baseline Sleep Disturbance and Inability to Discontinue Chronic Hypnotic Use

Abstract

Abstract Introduction Clinicians prescribing hypnotics remain concerned regarding the inability to discontinue hypnotics after chronic use, which has never been directly tested in a controlled prospective study using self-administration choice methodology. This study reports on difficulty discontinuing medication as a function of basal sleep disturbance in insomnia subjects instructed to stop taking their study medication after 6 months of nightly use. Methods DSM-V diagnosed insomnia subjects, aged 23-61 yrs, (n=39, 34 females), with no other sleep disorders, unstable medical or psychiatric diseases or drug dependency completed the trial. Following a screening polysomnogram participants were randomized to zolpidem XR (12.5 mg), eszopiclone (3 mg), or placebo nightly for 6 months (blinded groups A: n=15, B: n=11, C: n=13). After 6 months, nightly use, over a 2-week choice period, they were instructed to discontinue hypnotic use, but if necessary, to self-administer either 1, 2, or 3 capsules of their assigned “blinded” medication (zolpidem XR 6.25 mg, 6.25 mg, placebo; eszopiclone 2 mg, 1 mg, placebo as capsules 1, 2 and 3 respectively; or 3 placebos). Results Over the 14 nights 20 subjects took zero (51%) capsules; among the 19 taking capsules the median number chosen was 3. Most took one capsule per night; 6 took > 1 capsules on a given night. Importantly 1 subject took every capsule (42) available. Overall, the number of capsules taken declined from week 1 to 2 (p< .005). Those with baseline PSG SE <81% did not reduce capsule choice from week 1 to 2 (p<.02). Group A choose more capsules than groups B and C (p<.01). Conclusion The majority (85%) of the participants discontinued 6-month nightly hypnotic use (i.e. took < 6 total capsules over the 14 discontinuation nights) and among those taking capsules the rate declined from week 1 to 2. Baseline SE <81% may help identify those with difficulty discontinuing. Support (If Any) NIDA, grant#: R01DA038177 awarded to Dr. Roehrs.