Despite the proliferation of safe, effective, and cost-effective behavioral treatments of insomnia, hypnotic medication remains the most common treatment of insomnia by primary care providers. Such treatment in many cases leads to a pattern of tolerance and dependence on sleep medication, as well as difficulty discontinuing treatment and subsequent rebound insomnia. Recent research suggests promise for behavioral interventions in the treatment of hypnotic dependent insomnia. In this article, the authors report on the treatment of a particularly challenging case: an older adult with a history of addictive behavior now dependent on hypnotics. The authors demonstrate the best possible outcome: elimination of sleep medication combined with sleep improvement.
Get full access to this article
View all access options for this article.
References
1.
Ashton, H. (1994). Guidelines for the rational use of benzodiazepines: When and what to use. Drugs, 48, 25-40.
2.
Espie, C. A., Lindsay, W. R., & Brooks, D. N. (1988). Substituting behavioral treatment for drugs in the treatment of insomnia: An exploratory study. Journal of Behavior Therapy and Experimental Psychiatry, 19, 51-56.
3.
Everitt, D. E., Avorn, J., & Baker, M. W. (1990). Clinical decision-making in the evaluation and treatment of insomnia. American Journal of Medicine, 89, 357-362.
4.
Foley, D. J., Monjan, A. A., Brown, S. L., Simonsick, E. M., Wallace, R. B., & Blazer, D. G. (1995). Sleep complaints among elderly persons: An epidemiologic study of three communities. Sleep, 18, 425-432.
5.
Ford, D. E., & Kamerow, D. B. (1989). Epidemiologic study of sleep disturbances and psychiatric disorders: An opportunity for prevention? Journal of the American Medical Association, 262, 1479-1484.
6.
Greenblatt, D. J., Harmatz, J. S., Zinny, M. A., & Shader, R. I. (1987). Effect of gradual withdrawal on the rebound sleep disorder after discontinuation of triazolam. New England Journal of Medicine, 317, 722-728.
7.
Guilleminault, C. (1990). Benzodiazepines, breathing, and sleep. American Journal of Medicine, 88(Suppl. 3A), 25S-28S.
8.
Guilleminault, C., & Silvestri, R. (1982). Aging, drugs and sleep. Neurobiology of Aging, 3, 379-386.
9.
Herings, R.M.C., Stricker, B.H.C., de Boer, A., Bakker, A., & Sturmans, F. (1995). Benzodiazepines and the risk of falling leading to femur fractures: Dosage more important than elimination half-life. Archives of Internal Medicine, 155, 1801-1807.
10.
Humphreys, S. A., & Hallstrom, C. (1995). Benzodiazepine discontinuation phenomena. In D. J. Nutt & W. B. Mendelson (Eds.), Bailliere's clinical psychiatry (Vol. 1, No. 3, pp. 485-503). London: Bailliere Tindall.
11.
Institute of Medicine. (1979). Sleeping pills, insomnia, and medical practice. Washington, DC: National Academy of Sciences.
12.
Kales, A., Scharf, M. B., & Kales, J. D. (1978). Rebound insomnia: A new clinical syndrome. Science, 201, 1039-1041.
13.
Kirmil-Gray, K., Eagleston, J. R., Thoresen, C. E., & Zarcone, V. P., Jr. (1985). Brief consultation and stress management treatments for drug-dependent insomnia: Effects on sleep quality, self-efficacy, and daytime stress. Journal of Behavioral Medicine, 8, 79-99.
14.
Lichstein, K. L., & Johnson, R. S. (1993). Relaxation for insomnia and hypnotic medication use in older women. Psychology and Aging, 8, 103-111.
15.
Lichstein, K. L., & Morin, C. M. (Eds.). (2000). Treatment of late-life insomnia. Thousand Oaks, CA: Sage.
16.
Lichstein, K. L., Peterson, B. A., Riedel, B. W., Means, M. K., Epperson, M. T., & Aguillard, R. N. (1999). Relaxation to assist sleep medication withdrawal. Behavior Modification, 23, 379-402.
17.
Lichstein, K. L., & Riedel, B. W. (1994). Behavioral assessment and treatment of insomnia: A review with an emphasis on clinical application. Behavior Therapy, 25, 659-688.
18.
Mellinger, G. D., Balter, M. B., & Uhlenhuth, E. H. (1985). Insomnia and its treatment. Archives of General Psychiatry, 42, 225-232.
19.
Moran, M. G., Thompson, T. L., & Nies, A. S. (1988). Sleep disorders in the elderly. American Journal of Psychiatry, 145, 1369-1378.
20.
Morin, C. M. (1993). Insomnia: Psychological assessment and management. New York: Guilford.
21.
Morin, C. M., Colecchi, C. A., Ling, W. D., & Sood, R. K. (1995). Cognitive behavior therapy to facilitate benzodiazepine discontinuation among hypnotic-dependent patients with insomnia. Behavior Therapy, 26, 733-745.
22.
Morin, C. M., Stone, J., McDonald, K., & Jones, S. (1994). Psychological management of insomnia: A clinical replication series with 100 patients. Behavior Therapy, 25, 291-309.
23.
National Institutes of Health. (1991). The treatment of sleep disorders of older people, March 26-28, 1990. Sleep, 14, 169-177.
24.
National Institutes of Health, Consensus Development Conference. (1984). Drugs and insomnia: The use of medications to promote sleep. Journal of the American Medical Association, 251, 2410-2414.
25.
Neutel, C. I. (1995). Risk of traffic accident injury after a prescription for a benzodiazepine. Annals of Epidemiology, 5, 239-244.
26.
Oster, G., Russell, M. W., Huse, D. M., Adams, S. F., & Imbimbo, J. (1987). Accident- and injury-related health-care utilization among benzodiazepine users and nonusers. Journal of Clinical Psychiatry, 48(12, Suppl.), 17-21.
27.
Petursson, H., & Lader, M. (1984). Dependence on tranquilizers. New York: Oxford University Press.
28.
Quera-Salva, M. A., Orluc, A., Goldenberg, F., & Guilleminault, C. (1991). Insomnia and use of hypnotics: Study of a French population. Sleep, 14, 386-391.
29.
Ray, W. A., Griffin, M. R., & Downey, W. (1989). Benzodiazepines of long and short elimination half-life and the risk of hip fracture. Journal of the American Medical Association, 262, 3303-3307.
30.
Riedel, B. W., Lichstein, K. L., Peterson, B. A., Epperson, M. T., Means, M. K., & Aguillard, R. N. (1998). A comparison of the efficacy of stimulus control for medicated and non-medicated insomniacs. Behavior Modification, 22, 3-28.
31.
Schneider-Helmert, D. (1988). Why low-dose benzodiazepine-dependent insomniacs can't escape their sleeping pills. Acta Psychiatrica Scandinavica, 78, 706-711.
32.
Schweizer, E., Rickels, K., Case, W. G., & Greenblatt, D. J. (1990). Long-term therapeutic use of benzodiazepines. II. Effects of gradual taper. Archives of General Psychiatry, 47, 908-915.
