Chronic hypnotic-drug use. Ineffectiveness, drug-withdrawal insomnia, and dependence

Ten patients, each of whom had been using hypnotic drugs for periods ranging from months to years, were monitored in the sleep laboratory while continuing to receive medication. Comparison with insomniac controls who were not receiving medication demonstrated a significant decrease of rapid eye movement (REM) sleep in the chronic drug users. A striking finding was the fact that all of these patients had as great or greater difficulty in falling asleep or staying asleep, or both, than the insomniac controls who were not using medication. Abrupt withdrawal of ineffective drugs is not recommended due to psychological and physiological changes that contribute to drug-withdrawal insomnia and hypnotic-drug dependence. The ineffectiveness of hypnotic drugs demonstrated in this study and in our earlier sleep laboratory drug evaluation studies indicates the need for changes in the guidelines used for evaluating and advertising hypnotic drugs.