INSOMNIA WATCH

Temazepam: Safe for Older Adults

Benzodiazepine-hypnotic agents are commonly prescribed to older adults who have problems sleeping. According to the results of a study published in Human Psychopharmacology (January 2003), these adults can be confident that temazepam is a safe option for treating their insomnia.

Safety was assessed in patients aged 55 and older who suffered from either chronic or primary insomnia and were treated with temazepam (7.5, 15, 22.5, and 30 mg), combination temazepam + cognitive-behavioral therapy, or placebo. All patients experienced a generally low incidence of adverse events (AEs). Only 7.8% and 8.3% of the patients in the temazepam and combination groups, respectively, reported AEs; the highest incidence of AEs (10.8%) occurred in the placebo group. These findings did not differ significantly, but, interestingly, more neurosensory AEs occurred at 30 mg in the placebo group, compared with the temazepam or combination groups. The number of residual sedation complaints did not differ significantly between the placebo and treatment groups.

The study participants most commonly experienced mild AEs, and none reported serious AEs during the study. According to physician assessments, the severity of AEs such as anxiety, drowsiness, and headache decreased significantly over the 8-week treatment period. Additionally, temazepam therapy was highly tolerable: patients taking the drug alone rated their overall compliance slightly higher (4.7 out of 5), compared with participants taking placebo (4.6).

Insomnia Now, Work Disability Later

Fewer studies than might be expected have focused on the societal and economic costs of insomnia. Sleep disorders significantly impact workplace function, yet the relationship between insomnia and work disability, for example, had not been elucidated until an article was published in the June 2006 issue of the American Journal of Epidemiology.

In this study, researchers completed a historical review of the health and disability status of >37,000 Norwegian workers. Insomnia was determined to be a strong predictor of future and permanent work disability in the workers. This predictive effect was only marginally influenced by age, gender, and certain health behaviors; however, comorbid anxiety and depression were important factors in this phenomenon.

The findings suggested that strategies to treat insomnia, as well as associated anxiety and depression, may have positive economic effects.

Hypnotic Agent Improves Pilots'Sleep

An effective insomnia drug must provide an adequate period of sleep that is not followed by a "hangover"and diminished functioning. Research published in Aviation, Space, and Environmental Medicine (February 2003) demonstrated that the hypnotic agent temazepam appears to satisfy these criteria.

Helicopter pilots who worked at night were dosed with 30 mg of temazepam to induce sleep during the daytime. The aviators who received this hypnotic dose slept longer and with less fragmentation than those dosed with placebo. Temazepam-treated pilots generally reported less fatigue and more alertness after awakening, compared with those in the placebo group.

The study authors confirmed that temazepam is an effective sleep therapy that can reduce postslumber fatigue and increase subsequent alertness. This medication may have particular value as a sleep agent for those who maintain reversed sleep/work cycles, such as military pilots or shift workers.

Chronic Pain Is Associated with Poor Sleep

Chronic pain often is associated with disturbed sleep, although it is not clear whether sleep problems are the cause or the effect of this type of pain. A recent, prospective, cross-sectional study addressed this question by assessing the relationship between chronic back pain and impaired sleep.

Reported in the American Journal of Physical Medicine & Rehabilitation (May 2006), the study revealed a connection between low sleep quality and high measures of pain in 268 adult patients who had experienced >6 months of low back pain. The researchers discovered a significant, direct correlation between patient-reported scores on the Short-Form McGill Pain Questionnaire and the Pittsburgh Sleep Quality Index (PSQI).

There also was a significant correlation between patients' scores on a pain visual analog scale and both PSQI scores and overall sleep quality.

A significant relationship between pain and sleep disturbance was revealed: the proportion of participants reporting light or restless sleep rose by 55% after the onset of pain. Patients'low back pain was characterized most often as moderate to severe, and the most common problems were trouble falling asleep and interrupted sleep. The patients did not tend to increase their use of sleep medications in response to the chronic pain and low-quality sleep.

The study suggested that health care providers should regularly inquire about their patients'sleep patterns. Addressing sleep problems also appears to be an integral part of management programs for those suffering from chronic pain.