Management and evolution of insomnia complaints among non-substance-misusers in a Swiss remand prison.

Abstract

Insomnia is a frequent though rarely investigated problem among prisoners. The study's aim was to examine the clinical management of insomnia complaints in non-substance-misusing (NSM) prisoners (quality of medical consultation, effectiveness of drug prescription), and the risk of leaving prison with ongoing hypnotic prescription which might provoke withdrawal symptoms and encourage further hypnotic use outside prison. Retrospective study of the medical records of 112 NSM prisoners complaining of insomnia at medical consultation over a one year period at the outpatient-service of the Champ-Dollon remand prison (Geneva, Switzerland). We examined insomnia management by the general practitioners (anamnestic and clinical evaluation documented in the record), type, duration and effectiveness of treatment. The 112 records show a prescription of hypnotics to 111 patients (80% benzodiazepines or Zolpidem), a limited documented insomnia work-up (anamnestic information about sleep habits, sleep latency and previous hypnotic use for less than a third of the patients, about the impact of insomnia, such as fatigue, on daily activity in only 7%). In more than 60% of the patients, insomnia complaints persisted for more than 3 weeks. In 41 (37%) patients, improvement (defined subjectively based on patients' complaints) was complete, in 20 (18%) absent, and in 34 (30%) incomplete while taking the prescribed hypnotics. Patients without or with only partial improvement of insomnia received the highest number of hypnotics (mean 2.4, vs. 1.4 for patients with total improvement, 95% CI of the difference: 0.7-1.4). 55% of the 112 prisoners left prison with hypnotics still being prescribed. Our results show that prison physicians' evaluation for insomnia was incomplete. Drug prescription did not seem to have been an effective treatment for insomnia complaints in a sizeable number of patients. Many prisoners leave the prison with benzodiazepine prescription still ongoing and could be at risk for continued hypnotic use following imprisonment.