Insomnia is a common and often disabling condition affecting the adult working and elderly population with a prevalence ranging from 6 to 48% in the United Kingdom.[1] Half of those with insomnia seek medical help for their condition[2] and this often involves prescription of a benzodiazepine such as temazepam or a Z-drug such as zopiclone, zolpidem or zaleplon.
Drug treatment is often given long term inappropriately and this includes 50% of new prescriptions.[3] As a result over £22m is spent in primary care on 10 million (m) items of hypnotic drugs[4] and this figure has shown little decline in the past 5 years.
Lincolnshire, a large rural county, has a high rate of prescribing of hypnotic drugs relative to other counties within the Trent Strategic Health Authority and the UK generally, with a growing rate of prescribing z-drugs. In Lincolnshire alone the cost of Z-drugs for 108k prescriptions is £300k per annum. For 77k prescriptions of benzodiazepines the cost is £123k per annum (2005-6 figures). Although hypnotic drugs do work, the benefits are small compared to potential side effects, which include adverse cognitive and psychomotor effects and daytime sleepiness which may continue for several months after stopping the drug.[5] This is particularly true in older patients for whom hypnotics are more likely to be prescribed. In turn, further complications like falls, fractures and road traffic collisions may arise.[6] These drugs also have considerable potential for tolerance and addiction.
References
- Taylor S, Mccracken CFM, Wilson KCM, Copeland JRM. Extent and appropriateness of benzodiazepine use. Results from an elderly urban community. British Journal of Psychiatry 1998:173: 433-438. [Abstract]
- Aikens JE, Rouse ME. Help-seeking for insomnia among adult patients in primary care. J Am Board Fam Pract 2005:18: 257-261. [Free Full-text]
- van der Hooft CS, Jong GW, Dieleman JP et al. Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria–a population-based cohort study. Br J Clin Pharmacol 2005:60: 137-144. [Free Full-text]
- What’s wrong with prescribing hypnotics? Drug Ther Bull 2004:42: 89-93. [Abstract]
- Barker MJ, Greenwood KM, Jackson M, Crowe SF. Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis. Arch Clin Neuropsychol 2004:19: 437-454. [Free Full-text]
- Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 2005:331: 1169. [Free Full-text