0418 Blinded Hypnotic Tapering Promotes Hypnotic Discontinuation. (27th April 2018)

• Record Type: Journal Article
• Authors: Edinger, J D; Wamboldt, F; Holm, K; Johnson, R L; Simmons, B; Tsai, S; Morin, C M
• Is Part Of: Sleep. Volume 41(2018)Supplement 1
• Page Start: A158
• Page End: A159
• Publication Date: 2018-04-27
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsy061.417
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Many hypnotic users make repeated unsuccessful attempts to discontinue their hypnotics. This study is testing blinded tapering protocols to reduce anxiety and help patients discontinue their hypnotics. Methods: This study is enrolling users of benzodiazepine and benzodiazepine receptor agonists. Enrollees complete a two-week baseline including sleep diaries, actigraphy, the Insomnia Severity Index (ISI) and Benzodiazepine Withdrawal Questionnaire (BWQ). They then complete 4 sessions of cognitive behavioral insomnia therapy (CBTI). Subsequently they are randomized to one of three 20-week, double-blinded tapering protocols wherein their medication dosage is either reduced by 25% or 10% every two weeks, or remains unchanged (CTRL). During tapering, all enrollees are seen biweekly by the study physician for support and guidance. At the end of the 20-week period the study blind is eliminated and those who completed one of the two tapering protocols enter a 3-month follow-up period whereas CTRL participants are offered an open label taper before completing follow-up. Results: A total of 60 (M age = 55.8 ± 12.6 yrs.; 37 women) hypnotic users have been enrolled and started treatment. Thirty-eight have completed the CBTI phase, 22 have reached the end of the tapering, and 14 have completed the 3 month follow-up. Baseline ISI scores suggested moderately severe insomnia complaints (ISI=15.9 ± 0.73). These scores declined to the sub-clinical range by the post CBTI (10.92 ± 0.78) and tapering (9.50±.75) phases and into the normative range by follow-up (7.64 ± 1.65). BWQ scores remained fairly stable from baseline (3.00 ± 0.45) to post CBTI (3.51±.68) but declined by the end of tapering (1.67 ± 0.81). Of the 14 who completed one blind tapering protocols, 12 (86%) totally discontinued their medication use by the end of tapering whereas none in the CTRL group had chosen to do so. At follow-up 7 of 9 (78%) who completed blinded tapering remained medication free whereas 2 of 5 (40%) in the CTRL who underwent open-label tapering remained medication free. Conclusion: CBTI combined with blinded hypnotic tapering seems a promising treatment approach to help hypnotic users overcome their medication dependence and improve insomnia symptoms. Support (If Any): National Institute of Drug Abuse, R34 DA042329-01.