Insomnia, the experience of poor quality or quantity of sleep, is a very common complaint. Approximately 65 million adults (36% of the American population) complain of poor sleep, and of this group, 25% have
insomnia on a chronic basis. These chronic insomniacs not only report higher rates of difficulty with concentration, memory and the ability to cope with minor irritations but also have 2.5 times more
fatigue-related automobile accidents than do good sleepers. Despite its ubiquity,
insomnia is often either untreated or inadequately treated. Short-acting
hypnotics are advocated for
transient insomnia, which lasts less than 3 weeks, and in patients with
chronic insomnia as an adjunctive treatment where nonpharmacological treatment is not sufficient to alleviate
insomnia and the related daytime detrimental effects. The putative adverse effects of
hypnotics must be weighted against the severe health effects caused by continued sleep impairment. If
hypnotic agents are used, they should be taken nightly only for brief use, or intermittently in longer term use.
Benzodiazepines,
zolpidem and
zopiclone (in countries where the latter is available) remain the recommended
hypnotic agents, although in the past few years there has been much criticism in lay magazines and on television about the use of
benzodiazepines. However, this review of the efficacy and tolerability data of the short-acting
hypnotics suggests that
triazolam is comparable with other short-acting
hypnotics at equipotent doses while taking into consideration that for every
hypnotic, different study populations display different degrees of efficacy. In addition, contrary to previous suggestions that such adverse effects are
rebound insomnia and
anterograde amnesia are unique to
triazolam, hypnotically equivalent doses of tirazolam have not been shown to produce these effects more frequently than other short-acting
hypnotics. The newer nonbenzodiazepine
hypnotics seem to be equally efficacious as the short-acting
benzodiazepines; whether they will truly have a better adverse effect profile will be determined as more clinical experience accumulates. Despite the availability, relative safety and efficacy of these newer
hypnotic agents, they should not be perceived as the sole treatment for
insomnia and should be used in conjunction with nonpharmacological techniques (such as adherence to good sleep hygiene, sleep restriction, stimulus control and
biofeedback therapy).