Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Insomnia (Part 2)
Andrew Wood, Regional Pharmacist Manager, Ward MM
This week sees a continuation of a discussion of insomnia in the aged care setting.
- Short-acting Benzodiazepines such as temazepam should be reserved for acute insomnia that is not responding to the non-pharmacological measures. Long-acting benzodiazepines have a poor efficacy vs adverse effect ratio for insomnia. Tolerance to benzodiazepine hypnotic effects develops rapidly, and efficacy is lost after approximately 2 weeks of consistent use.
- Convincing residents they are no longer benefiting clinically from their sleeping tablet is difficult, and there is a significant contribution from the placebo effect. Adverse effects on balance and gait leading to increased falls risk, as well as confusion and reduced cognition may persist despite the loss of efficacy.
- Zolpidem and zopiclone have no clear advantages over temazepam in terms of safety or efficacy, and are more expensive.
- Newer options available for longer-term management are melatonin and suvorexant. Melatonin is a neurotransmitter normally made in the brain to control our sleep patterns; studies have investigated use for up to a 3-month course. Suvorexant blocks orexin, a neurotransmitter that keeps us awake. It is meant for regular use, and studies have not shown any effect on daytime drowsiness or balance.
- There are no convincing studies on the benefits of natural remedies such as valerian, hops or passionflower.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to email@example.com.