[Benefits and risks of hypnotics]

Gradual withdrawal of zopiclone (7.5 mg) and zolpidem (10 mg) in insomniacs treated for at least 3 months

Two distinct double-blind randomized multicentre studies were undertaken at the same time using the same design. Patients treated for insomnia with zopiclone 7.5 mg or zolpidem 10 mg for at least three months were allocated to two groups: gradual withdrawal or control. In each study the two groups were compared but there was no comparison between zopiclone and zolpidem. The main criteria was the number of patients in each group with “withdrawal syndrome” defined as: the occurrence of an adverse event, or premature discontinuation of treatment or a total score increase of at least 3 points on the Tyrer questionnaire. In both studies the incidence of “withdrawal syndrome” as defined above was significantly higher in the “withdrawal” groups than in the “control” groups 38% vs 20% for zopiclone p = 0.008 and 38% vs 24% for zolpidem P = 0.049. In most cases, the notified symptoms were sleep complaints.

"Brain music" in the treatment of patients with insomnia

The effects of a new nonpharmacological method of treating insomnia-"brain music"-were studied. The method is based on the transformation of the EEG into music using a special algorithm developed by the authors. Sleep polygrams were recorded and analyzed, and EEG segments corresponding to different sleep phases were identified using standard criteria, and were transformed into music. Patients listened to the resulting audio cassettes before going to sleep. Clinical, questionnaire, psychological, and electrophysiological (polysomnographic, electroencephalographic) methods were used before and after 15-day treatment courses in 58 patients with insomnia, who were divided into two groups: group 1 (44 patients) formed the experimental group, and group 2 (14 patients) formed the "placebo" group (in whom the "brain music" of a different patient was used). "Brain music" was found to have positive effects in more than 80% of the insomniac patients both from the point of view of subjective sensations and in terms of objective studies, i.e. neuropsychological and neurophysiological investigations. The high efficacy of "brain music" in patients with insomnia was combined with an absence of side effects and complications.

Pharmacotherapy of insomnia: practice and prospects

Insomnia is a complex complaint which is often multifactorial in origin. Pharmacotherapy can only be an adjunct in the treatment of insomnia and hypnotics should be given on an intermittent basis for short periods of time. An overview is presented of the currently available hypnotics, of which benzodiazepines are still the most widely prescribed. New drugs which bind to specific receptor subtypes or which are partial benzodiazepine receptor agonists might overcome the disadvantages associated with chronic benzodiazepine use, but more long-term investigations are needed.