16 Benzodiazepine Medical Use: Sleep
Table of Contents
16.1 Pharmaceutical Industry. 1
16.10 Comparative Outcomes: Medications. 6
16.11 Comparative Outcomes: Non-Pharmacologic Approaches. 7
16.12 Combination Outcomes: Other Medications. 8
16.13 Combination Outcomes: Non-Pharmcologic Approaches. 8
16.14 Benzodiazepines for Sleep by Subpopulation. 8
See Also
Insomnia
Z Drugs
Benzodiazepine Effects
Benzodiazepine Non-Medical Use
16.1 Pharmaceutical Industry |
Estazolam
Prescribing Information: Estazolam
Approved on the basis of three 7-night placebo controlled trials, one 12-week placebo controlled trial
Flurazepam
Dalmane
Prescribing Information: Dalmane
Greenblatt DJ, Divoll M, Harmatz JS, et al. Kinetics and clinical effects of flurazepam in young and elderly noninsomniacs. Clin Pharmacol Ther. 1981;276(30):475-86. Abstract
Midazolam
Prescribing Information: Midazolam
Temazepam
Restoril
Prescribing Information: Restoril
Triazolam
Halcion
Prescribing Information: Halcion
16.2 Reviews |
Expert Opinion
Hoffmann F. Benefits and risks of benzodiazepines and Z-drugs: comparison of perceptions of GPs and community pharmacists in Germany. Ger Med Sci. 2013;11:Doc10. Article
Pagel JF, Parnes BL. Medications for the treatment of sleep disorders: an overview. Prim Care Companion J Clin Psychiatry. 2001;3(3):118-25. Article
Guidelines
Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13(2):307-349. Abstract
Meta – Analyses
Holbrook AM, Crowther R, Lotter A, et al. Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ. 2000;162(2):225-33. Article
Reviews
Buscemi N, Vandermeer B, Friesen C, et al. The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs. J Gen Intern Med. 2007;22(9):1335-50. Article
Curran HV, Collins R, Fletcher S, et al. Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life. Psychol Med. 2003;33(7):1223-37. Abstract
Kales A, Kales JD. Sleep laboratory studies of hypnotic drugs: efficacy and withdrawal effects. J Clin Psychopharmacol. 1983;3(2):140-50. Abstract
Schroeck JL, Ford J, Conway EL, et al. Review of safety and efficacy of sleep medicines in older adults. Clin Ther. 2016;38(11):2340-2372. Abstract
16.3 Epidemiology of Use |
Bachmann CS, Berg EA, Spigset O, Slørdal L. Benzodiazepine-like hypnotics – attitudes and prescription practice among general practitioners. Tidsskr Nor Laegeforen. 2008;128(2):166-70. Abstract
Hoffmann F. Benefits and risks of benzodiazepines and Z-drugs: comparison of perceptions of GPs and community pharmacists in Germany. Ger Med Sci. 2013;11:Doc10. Article
16.4 Economics |
Dündar Y, Boland A, Strobl J, et al. Newer hypnotic drugs for the short-term management of insomnia: a systematic review and economic evaluation. Health Technol Assess. 2004;8(24):iii-x, 1-125. Article
Touitou Y. Sleep disorders and hypnotic agents: medical, social and economical impact. Ann Pharm Fr. 2007;65(4):230-8. Abstract
16.5 Estazolam |
Bu J, Zhuo XY. The influence of estazolam on human neurobehavioral function. Fa Yi Xue Za Zhi. 2010;26(1):30-2. Abstract
Gustavson LE, Carrigan PJ. The clinical pharmacokinetics of single doses of estazolam. Am J Med. 1990;88(3A):2S-5S. Abstract
Lamphere J, Roehrs T, Zorick F, et al. Chronic hypnotic efficacy of estazolam. Drugs Exp Clin Res. 1986;12(8):687-91. Abstract
Mauro C, Sperlongano P. Controlled clinical evaluation of 2 hypnotic triazole benzodiazepines, estazolam and triazolam, used the night before surgical interventions. Minerva Med. 1987;78(18):1381-4. Abstract
Pierce MW, Shu VS. Efficacy of estazolam. The United States clinical experience. Am J Med. 1990;88(3A):6S-11S. Abstract
Pierce MW, Shu VS, Groves LJ. Safety of estazolam. The United States clinical experience. Am J Med. 1990;88(3A):12S-17S. Abstract
Wang XL, Ke YN, Effects of midazolam and estazolam as hypnotics in hypertensive patients with chronic insomnia: a multicentre, open labeled, randomized clinical trial. Midazolam Trenting Hypentension with Insomnia Study Group. Zhonghua Xin Xue Guan Bing Za Zhi. 2006;34(4):338-40. Abstract
Yen CF, Ko CH, Chang YP, et al. Dependence, misuse, and beliefs regarding use of hypnotics by elderly psychiatric patients taking zolpidem, estazolam, or flunitrazepam. Asia Pac Psychiatry. 2015;7(3):298-305. Abstract
16.6 Flurazepam |
Chernik DA, Johnson LC, Kanitra L. Sleep, performance, and plasma levels in chronic insomniacs during 14-day use of flurazepam and midazolam: methodology. J Clin Psychopharmacol. 1990;10(4 Suppl):10S-19S. Abstract
Dement WC. Objective measurements of daytime sleepiness and performance comparing quazepam with flurazepam in two adult populations using the Multiple Sleep Latency Test. J Clin Psychiatry. 1991;52 Suppl:31-7. Abstract
Greenblatt DJ, Shader RI, Koch-Weser J. Flurazepam hydrochloride, a benzodiazepine hypnotic. Ann Intern Med. 1975;83(2):237-41. Abstract
Hilbert JM, Battista D. Quazepam and flurazepam: differential pharmacokinetic and pharmacodynamic characteristics. J Clin Psychiatry. 1991;52 Suppl:21-6.
Johnson LC, Chernik DA, Sateia MJ. Sleep, performance, and plasma levels in chronic insomniacs during 14-day use of flurazepam and midazolam: an introduction. J Clin Psychopharmacol. 1990;10(4 Suppl):5S-9S. Abstract
Judd LL, Ellinwood E, McAdams LA. Cognitive performance and mood in patients with chronic insomnia during 14-day use of flurazepam and midazolam. J Clin Psychopharmacol. 1990;10(4 Suppl):56S-67S. Abstract
Kales A, Bixler EO, Soldatos CR, et al. Quazepam and flurazepam: long-term use and extended withdrawal. Clin Pharmacol Ther. 1982;32(6):781-8. Abstract
Moskowitz H, Linnoila M, Roehrs T. Psychomotor performance in chronic insomniacs during 14-day use of flurazepam and midazolam. J Clin Psychopharmacol. 1990;10(4 Suppl):44S-55S. Abstract
16.7 Midazolam |
Altamimi MI, Sammons H, Choonara I. Inter-individual variation in midazolam clearance in children. Arch Dis Child. 2015;100(1):95-100. Article
Bellolio MF, Gilani WI, Barrionuevo P, et al. Incidence of adverse events in adults undergoing procedural sedation in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2016;23(2):119-34. Article
Chernik DA, Johnson LC, Kanitra L. Sleep, performance, and plasma levels in chronic insomniacs during 14-day use of flurazepam and midazolam: methodology. J Clin Psychopharmacol. 1990;10(4 Suppl):10S-19S. Abstract
Johnson LC, Chernik DA, Sateia MJ. Sleep, performance, and plasma levels in chronic insomniacs during 14-day use of flurazepam and midazolam: an introduction. J Clin Psychopharmacol. 1990;10(4 Suppl):5S-9S. Abstract
Judd LL, Ellinwood E, McAdams LA. Cognitive performance and mood in patients with chronic insomnia during 14-day use of flurazepam and midazolam. J Clin Psychopharmacol. 1990;10(4 Suppl):56S-67S. Abstract
Moskowitz H, Linnoila M, Roehrs T. Psychomotor performance in chronic insomniacs during 14-day use of flurazepam and midazolam. J Clin Psychopharmacol. 1990;10(4 Suppl):44S-55S. Abstract
Roth T, Roth T, Zorick F, et al. The effects of midazolam and temazepam on sleep and performance when administered in the middle of the night. J Clin Psychopharmacol. 1985;5(2):66-9. Abstract
Vogel GW, Vogel F. Effect of midazolam on sleep of insomniacs. Br J Clin Pharmacol. 1983;16 Suppl 1:103S-108S. Article
Wang XL, Ke YN, Effects of midazolam and estazolam as hypnotics in hypertensive patients with chronic insomnia: a multicentre, open labeled, randomized clinical trial. Midazolam Trenting Hypentension with Insomnia Study Group. Zhonghua Xin Xue Guan Bing Za Zhi. 2006;34(4):338-40. Abstract
Yuan R, Flockhart DA, Balian JD. Pharmacokinetic and pharmacodynamic consequences of metabolism-based drug interactions with alprazolam, midazolam, and triazolam. J Clin Pharmacol. 1999;39(11):1109-25. Abstract
16.8 Temazepam |
Cuanang JR, Limos L. Treatment of insomnia with temazepam: double-blind, placebo-controlled evaluation. Clin Ther. 1982;4(5):402-12. Abstract
Heel RC, Brogden RN, Speight TM, Avery GS. Temazepam: a review of its pharmacological properties and therapeutic efficacy as an hypnotic. Drugs. 1981;21(5):321-40. Abstract
Heffron WA,.Roth P, Double-blind evaluation of the safety and hypnotic efficacy of temazepam in insomniac outpatients. Br J Clin Pharmacol. 1979;8(1):69S-72S. Article
Kunsman GW, Manno JE, Manno BR, et al. The use of microcomputer-based psychomotor tests for the evaluation of benzodiazepine effects on human performance: a review with emphasis on temazepam. Br J Clin Pharmacol. 1992;34(4):289-301. Article
McElnay JC, Jones ME, Alexander B. Temazepam (Restoril, Sandoz Pharmaceuticals). Drug Intell Clin Pharm. 1982;16(9):650-6. Abstract
Mitler MM. Evaluation of temazepam as a hypnotic. Pharmacotherapy. 1981;1(1):3-13. Abstract
Roehrs T, Vogel G, Vogel F, et al. Dose effects of temazepam tablets on sleep. Drugs Exp Clin Res. 1986;12(8):693-9. Abstract
Roehrs T, Lamphere J, Paxton C, et al. Temazepam’s efficacy in patients with sleep onset insomnia. Br J Clin Pharmacol. 1984;17(6):691-6. Article
Roth T, Roth T, Zorick F, et al. The effects of midazolam and temazepam on sleep and performance when administered in the middle of the night. J Clin Psychopharmacol. 1985;5(2):66-9. Abstract
16.9 Triazolam |
Kales A, Bixler EO, Vela-Bueno A, et al. Comparison of short and long half-life benzodiazepine hypnotics: triazolam and quazepam. Clin Pharmacol Ther. 1986;40(4):378-86. Abstract
Martin VL. Appropriately treating insomnia with triazolam. J Psychoactive Drugs. 1990;22(1):35-43. Abstract
Mauro C, Sperlongano P. Controlled clinical evaluation of 2 hypnotic triazole benzodiazepines, estazolam and triazolam, used the night before surgical interventions. Minerva Med. 1987;78(18):1381-4. Abstract
Pakes GE, Brogden RN, Heel RC, et al. Triazolam: a review of its pharmacological properties and therapeutic efficacy in patients with insomnia. Drugs. 1981;22(2):81-110. Abstract
Rothschild AJ. Disinhibition, amnestic reactions, and other adverse reactions secondary to triazolam: a review of the literature. J Clin Psychiatry. 1992;53 Suppl:69-79. Abstract
Yuan R, Flockhart DA, Balian JD. Pharmacokinetic and pharmacodynamic consequences of metabolism-based drug interactions with alprazolam, midazolam, and triazolam. J Clin Pharmacol. 1999;39(11):1109-25. Abstract
16.10 Comparative Outcomes: Medications |
Benzodiazepines v Antihistamines
Grünberger J, Saletu B, Linzmayer L, et al. Comparative studies on the effects of the combination drug lorazepam plus diphenhydramine (Somnium) versus lorazepam on the noopsyche, thymopsyche and psychophysiology in nonorganic insomnia related to generalized anxiety disorder. Methods Find Exp Clin Pharmacol. 1997;19(9):645-54. Abstract
Saletu B, Saletu-Zyhlarz G, Anderer P, et al. Nonorganic insomnia in generalized anxiety disorder. 2. Comparative studies on sleep, awakening, daytime vigilance and anxiety under lorazepam plus diphenhydramine (Somnium) versus lorazepam alone, utilizing clinical, polysomnographic and EEG mapping methods. Neuropsychobiology. 1997;36(3):130-52. Abstract
GABA Receptor Agonists – Benzodiazepines v Benzodiazepines
Jonas JM, Coleman BS, Sheridan AQ, Kalinske RW. Comparative clinical profiles of triazolam versus other shorter-acting hypnotics. J Clin Psychiatry. 1992;53 Suppl:19-31; discussion 32-3. Abstract
Flurazepam v Estazolam
Cohn JB, Wilcox CS, Bremner J, Ettinger M. Hypnotic efficacy of estazolam compared with flurazepam in outpatients with insomnia. J Clin Pharmacol. 1991;31(8):747-50.
Dominguez RA, Goldstein BJ, Jacobson AF, Steinbook RM. Comparative efficacy of estazolam, flurazepam, and placebo in outpatients with insomnia. J Clin Psychiatry. 1986;47(7):362-5. Abstract
Scharf MB, Roth PB, Dominguez RA, Ware JC. Estazolam and flurazepam: a multicenter, placebo-controlled comparative study in outpatients with insomnia. J Clin Pharmacol. 1990;30(5):461-7. Abstract
Benzodiazepines v Z Drugs
Dündar Y, Dodd S, Strobl J, et al. Comparative efficacy of newer hypnotic drugs for the short-term management of insomnia: a systematic review and meta-analysis. Hum Psychopharmacol. 2004;19(5):305-22. Abstract
Hausken AM, Furu K, Skurtveit S, et al. Starting insomnia treatment: the use of benzodiazepines versus z-hypnotics. a prescription database study of predictors. Eur J Clin Pharmacol. 2009;65(3):295-301. Abstract
Li S, Wang C. A comparative study of imovane and estazolam treatment on sleep disturbances. Chin Med Sci J. 1995;10(1):56-8. Abstract
Rush CR. Behavioral pharmacology of zolpidem relative to benzodiazepines: a review. Pharmacol Biochem Behav. 1998;61(3):253-69. Abstract
GABA Receptor Agonists v Plant-Based Products
Maroo N, Hazra A, Das T. Efficacy and safety of a polyherbal sedative-hypnotic formulation NSF-3 in primary insomnia in comparison to zolpidem: a randomized controlled trial. Indian J Pharmacol. 2013;45(1):34-9. Article
16.11 Comparative Outcomes: Non-Pharmacologic Approaches |
Li HC, Chen XG, Tian X. Analysis on somnipathy related factors in elderly patients with stroke and comparative study on the efficacy of treatment by traditional Chinese medicine and by estazolam. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2009;29(3):204-7. Abstract
Li HC, Yang YL, Ma M. Comparative study on treatment of somnipathy in patients with hypertension by traditional Chinese medicine and by estazolam. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2007;27(2):123-6. Abstract
16.12 Combination Outcomes: Other Medications |
16.13 Combination Outcomes: Non-Pharmcologic Approaches |
16.14 Benzodiazepines for Sleep by Subpopulation |
Addiction
Armed Services / Veterans
Cancer
Cardiovascular Disease
Care Facilities
Cognitive Dysfunction
Criminal Justice
Elderly
Blachman NL, Leipzig RM, Mazumdar M, Poeran J. High-risk medications in hospitalized elderly adults: are we making it easy to do the wrong thing? J Am Geriatr Soc. 2017;65(3):603-607. Abstract
Grad RM. Benzodiazepines for insomnia in community-dwelling elderly: a review of benefit and risk. J Fam Pract. 1995;41(5):473-81. Abstract
Voyer P, Landreville P, Moisan J, et al. Insomnia, depression and anxiety disorders and their association with benzodiazepine drug use among the community-dwelling elderly: implications for mental health nursing. Int J Psychiatr Nurs Res. 2005;10(2):1093-116. Abstract
Vogel GW, Morris D. The effects of estazolam on sleep, performance, and memory: a long-term sleep laboratory study of elderly insomniacs. J Clin Pharmacol. 1992;32(7):647-51. Abstract
Ethnicity
African-American
Asian
Caucasian
Hispanic
Native American
Pacific Island
Health Care Providers
Hepatic Disease
HIV / AIDS
LGBT
Men
Palliative Care – End of Life
Hirst A, Sloan R. Benzodiazepines and related drugs for insomnia in palliative care. Cochrane Database Syst Rev. 2002;(4):CD003346. Abstract
Pain
Pediatric
Altamimi MI, Sammons H, Choonara I. Inter-individual variation in midazolam clearance in children. Arch Dis Child. 2015;100(1):95-100. Article
Psychiatric Disease
Anxiety
Post GL, Patrick RO, Crowder JE, et al. Estazolam treatment of insomnia in generalized anxiety disorder: a placebo-controlled study. J Clin Psychopharmacol. 1991;11(4):249-53. Abstract
Depression
Psychosis
Respiratory Disease
Cohn MA, Morris DD, Juan D. Effects of estazolam and flurazepam on cardiopulmonary function in patients with chronic obstructive pulmonary disease. Drug Saf. 1992;7(2):152-8. Abstract
Skatrud JB, Badr S, Begle RL, Juan D. Ventilatory response to single, high dose estazolam in healthy humans. J Clin Pharmacol. 1990;30(6):543-8. Abstract
Sleep Disordered Breathing
Mason M, Cates CJ, Smith I. Effects of opioid, hypnotic and sedating medications on sleep-disordered breathing in adults with obstructive sleep apnea. Cochrane Database Syst Rev. 2015;(7):CD011090. Abstract
Renal Disease
Surgery
Swallowing Disorders
Women
Perinatal
Nursing
