21 In older adults, there may be concerns about falls and hip fractures, motor vehicle accidents, and mortality, as well as concerns for undesirable drug interactions and polypharmacy effects. Long-term hypnotic use has raised concerns given findings of psychomotor and cognitive impairment, difficulties with discontinuation, and dependence liability that are associated with prolonged use. 18– 20 These patterns of long-term use hypnotic use are particularly common in primary care settings. However, about 65% of individuals who are prescribed sleep medication continue to use them for more than one year, with a substantial number of individuals continuing to use sleep medications for more than 5 years. 17 There are now 10 medications approved by the Food and Drug Administration to treat insomnia ( Table 1) and the recommended use is between 30 and 180 days. 14– 16 Currently, the most commonly used medications for insomnia include benzodiazepine receptor agonists (BzRAs), melatonin receptor agonists, and antidepressants. 10– 13 Overall, studies have demonstrated that hypnotics can improve sleep by reducing sleep onset latency and increasing total sleep time and these effects occur within the first week of initiating treatment. 8, 9 Approximately 3 to 10% of the general population use hypnotic medication, and this rate increases to 20% among older individuals. Historically, pharmacotherapy has been the first line treatment for insomnia and remains a popular choice of treatment. The aims of this paper are to present the issues related to chronic hypnotic use and to review the literature on the addition of CBTI to facilitate the discontinuation of hypnotic medication in chronic insomnia patients.

Specifically, cognitive-behavior therapy for insomnia (CBTI) has been used to aid in the discontinuation of chronic hypnotic use among those who began using hypnotics and have become chronic users. A sophisticated approach that has gained research attention and appears to be translatable to real-world clinical practice is to combine a pharmacological treatment with a non-pharmacological treatment. The accumulated research evidence supports the efficacy of both pharmacological and non-pharmacological treatments for insomnia, yet each of these treatment modalities has limitations in clinical practice. 1, 3– 7 Over the past 20 to 30 years, several clinical trials have examined the efficacy of various treatments for insomnia. 1, 2 Chronic insomnia is associated with significant morbidity, such as reduced quality of life, increased risk for psychiatric disorder, and higher risk for various physical diseases such as hypertension and diabetes. Insomnia is a highly prevalent disorder that affects 10–15% of the general population.

Key words: Insomnia, Cognitive-behavioral therapy for insomnia, Sleep medication discontinuation, Hypnotics, Pharmacotherapy Such an approach represents a more modern view of treating chronic insomnia patients by using both pharmacological and non-pharmacological tools. These findings indicate that rather than choosing between CBT and hypnotic medication, clinicians might be better served using both treatment modalities to optimize the relative strengths of each treatment. Although these results are promising, it should be noted that the long-term evidence is more equivocal, as over 40% of patients relapse in the need for sleep medication within 2 years, which may highlight the importance of adding follow-up booster sessions in hypnotic-dependent insomniacs. Across several randomized clinical trials, the majority of the findings indicate that using CBTI, delivered by a therapist or self-help, along with a supervised or gradual tapering program is superior to tapering only or CBTI only in terms of medication discontinuation. The current literature provides substantial support for using CBTI to facilitate discontinuation of hypnotic medication in chronic insomnia patients. The current article presents these challenges and reviews studies that have added cognitive-behavioral therapy for insomnia (CBTI) to a gradual tapering program to facilitate discontinuation of hypnotic medication in chronic insomnia patients. Many chronic insomnia patients use sleep medication well beyond the recommended duration, and patients who are hypnotic-dependent encounter several challenges when attempting to discontinue.

Icd 10 insomnia with reliance on ambien