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Kramer - Long Term Use of Benzos for Insomnia

Posted by fachad on April 1, 2002, at 8:32:33

Dr. Kramer:

My question is about the apparent discrepancy between theory and practice regarding the long term usage of benzodiazapine hypnotics for insomnia.

Anywhere I find written references in the literature, whether it be journals or textbooks, there is strong verbiage that does not leave much room for interpretation. The consensus is that hypnotics should not be prescribed for more than a few days, or a few weeks maximum.

Yet in the reality of the everyday practice of both GPs and Psychiatrists it seems extremely common for BZ hypnotics to be used very long term, sometimes indefinitely.

The other oddball in this whole mystery is Ambien. It too has a general recommendation for short-term use, but there are scattered written references to Ambien being acceptable for longer-term usage in some situations. Since it acts on the BZ receptor, shouldn’t the same restrictions that apply to the classical benzodiazapines apply to Ambien?

This issue is of personal concern to me because I have (amongst other things) chronic insomnia. I don't like Ambien because it's expensive, and it wears off too quickly, actually worsening my early morning awakenings.

My current psychiatrist is fine with me taking Ativan, but I just wonder why there is this huge incongruence in medicine between explicitly stated consensus positions against long term hypnotic usage, and the actual prescribing patterns of physicians who frequently do prescribe benzodiazapine hypnotics long term.

Any comments?




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