Sleeping Pills, Insomnia, and Medical Practice Report of a Study (1979) / Chapter Skim
Currently Skimming:
Introduction and Summary
Introduction and Summary
Pages 1-16
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 1... ...
The Institute of Medicine decided that the public health issues associated not only with the barbiturate hypnotics, but also with other hypnotic drugs, justified a study of the uses of all these substances in medical practice. The steering committee appointed to guide the study included specialists in consumer affairs, food and drug law, internal medicine, nursing, health professional education, pharmacology, psychiatry, and sleep disorders.
|
From page 2... ...
The Food and Drug Administration, having reviewed safety and efficacy studies of those preparations, recently initiated proceedings to withdraw most of them from the market. Alcohol, which often is used to induce sleep, is not discussed in depth except to document its inefficiency as a hypnotic agent and the additive nature of its undesirable effects when consumed with hypnotic drugs.
|
From page 3... ...
The committee's mandate and expertise lay in identifying implications of hypnotic prescribing and use for medical practice; therefore its deliberations centered on the first two categories. The committee recognizes that the demarcation among the categories is not absolute, and that even if the categories were more clearly defined it is not known what portion of the hypnotics involved in the various public health problems originates from each of the categories.
|
From page 4... ...
In middle and old age, stage and 3 and 4 sleep decreases markedly and sleep tends to become progressively more fragmented, with brief arousals and longer periods of wakefulness. Neurological mechanisms that underlie the different sleep states may significantly alter control of vital regulatory functions, such as breathing, temperature, and heart beat, with the result that some individuals who are physically normal while awake can develop serious respiratory or cardiac problems with asleep.
|
From page 5... ...
This build-up is of some concern because of demonstrated residual daytime effects on tasks requiring visual motor coordination. The most widely prescribed non-barbiturate, non-benzodiazepines are glutethimide (Doriden (R)
|
From page 6... ...
are given sleeping medication, apparently more as a hospital policy than in response to specific sleep complaints. Because physicians receive most of their clinical training in the hospital setting, it is reasonable to assume that exposure to casual prescribing of hypnotics would influence their future conduct in ambulatory practice.
|
From page 7... ...
Public Health Problems Associated with Hypnotics The public health problems associated with the wide availability of hypnotic medication include increased mortality from its use in suicide or accidental overdose; costs of treatment for non-fatal overdose emergencies; morbidity, mortality, increased crime and lost production due to addiction to these drugs; and potential hazards to public and personal safety from persons driving automobiles or operating other machinery while under the influence of these drugs. National statistics show that there was a 52 percent decrease between 1970 and 1976 in the number of suicides using barbiturates.
|
From page 8... ...
Each class of hypnotic drug and related psychotropic medication has its advantages and disadvantages, which should be weighed each time a prescription is written. Until recently, findings about the suppression of REM sleep by most hypnotic drugs were considered important in selecting hypnotics.
|
From page 9... ...
On the other hand, studies of hypnotic drugs' effects on highly selected severe insomniacs are not necessarily informative about their appropriate use with more typical patients. Although it has been estimated that in a given year more than one percent of the adult population will use sleeping pills on consecutive nights for a period of more than two months, little research has been conducted concerning the efficacy of long-term use of hypnotic medication for sleep.
|
From page 10... ...
The effects of hypnotics on sleep-related respiratory disturbancehave never been directly tested, but the central respiratory depressant effects of the barbiturates are well known, and similar effects have been found with the other hypnotics. Renal impairment is of particular concern with the use of benzodiazepines because of their long half-lives and psychoactive metabolizes.
|
From page 11... ...
Before prescribing a hypnotic for an elderly person, the physician would be wise to suggest non-pharmacological measures, such as establishing a ritual for retiring to bed, avoiding daytime naps, and increasing the daily amount of physical activity. CONCLUSIONS Clinical Practice, Patient Information, and Public Health The committee concludes that prudent clinical practice in the matter of sleep disorders should entail: -- a thorough medical and psychosocial appraisal of the insomniac patient before any decision to prescribe drugs for relief of the sleep complaint -- choosing a hypnotic drug on the basis of anticipated risks to individual patients - close monitoring by the physician of all patients receiving hypnotic drugs —11—
|
From page 12... ...
To reduce the ease of suicidal impulsive pill ingestion, the committee urges the evaluation of measures like individual pill packaging and enlarged pill size. To provide more accurate mortality and highway safety statistics, the committee recommends that modern toxicological screening for the benzodiazepines be added to the traditional tests for alcohol, opiates, and barbiturates.
|
From page 13... ...
In view of these studies, the committee recommends that physicians who prescribe flurazepam be advised to initially prescribe the lower dose for all patients, rather than, as is now the case, only for elderly or debilitated patients. Professional Education Although hypnotics are widely prescribed, the committee finds that physicians receive little specific education or clinical training in the physiology of sleep and use of hypnotic medication.
|
From page 14... ...
Another approach would be the establishment of a standing advisory committee to deal specifically with hypnotic drugs. Initiation and Coordination of Federal Efforts The committee urges that a central authority within the Public Health Service be formed promptly to review the current scientific and educational issues associated with sleep disorders and their treatment.
|
From page 15... ...
of REW, National Institute on Drug Abuse, 1977.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.