THE PROPER USE OF SLEEPING PILLS IN THE PRIMARY CARE SETTING

Insomnia is a highly prevalent problem occurring in about 35% of the adult population. The complaint can be divided into temporary insomnia and persistent insomnia. A 1983 NIMH/OMAR Consensus Development Conference on drugs and insomnia issued guidelines for the use of sleep-promoting medications. There was a consensus that hypnotic medication is indicated for the treatment of temporary insomnia. Temporary insomnia, in response to external circumstances, is real and can have very serious consequences. This paper reviews the proper use of sleeping pills in the primary care setting in the context of current controversy involving benzodiazepines in general and benzodiazepine hypnotics in particular. It is concluded if the physician feels a patient's temporary insomnia warrants symptomatic relief with medication, it is appropriate to prescribe use of the lowest effective dose of a benzodiazepine hypnotic for several nights. Depending on the circumstances, the physician can specify either a short-acting or a long-acting hypnotic. The patient should be firmly instructed to call the clinic or office the next day to report results.