Current state of hypnotic use disorders: Results of a survey using the Japanese version of Benzodiazepine Dependence Self-Report Questionnaire

Aims Benzodiazepine receptor agonists (BZ-RAs) are frequently prescribed to treat insomnia; however, their long-term use is not recommended. To introduce an appropriate pharmaco-therapy, the current state and background factors of BZ-RAs\u27 dependence must be elucidated. In this study, we developed a Japanese version of the Benzodiazepine Dependence Self-Report Questionnaire (Bendep-SRQ-J) and conducted a study of BZ-RAs\u27 use disorder. Methods The Bendep-SRQ-J was created with permission from the original developer. Subjects were inpatients and outpatients receiving BZ-RAs between 2012 and 2013. Clinical data collected were Bendep-SRQ-J scores, sleep disorders for which BZ-RAs were prescribed, physical comorbidities, psychotropic drugs, and lifestyle factors. Logistic analysis was performed to extract factors associated with severe symptoms. Results Of the 707 patients prescribed BZ-RAs, 324 had voluntarily tapered or discontinued their drugs. Logistic analysis showed that the total number of drugs administered in the last 6 months correlated with both worsening of symptoms or conditions. This was more notable among younger patients, and the proportion of patients with severe symptoms or conditions increased with the increasing number of drugs. Conclusion Using the Bendep-SRQ-J, we elucidated the current state of BZ-RA dependence. Nearly half of the patients were non-compliant. The proportion of patients with severe symptoms or disease conditions increased with the increase in the number of drugs administered. These findings highlight the need for clinicians to be aware of the likelihood of benzodiazepine dependence, especially in young patients and patients prescribed multiple hypnotics

Trends in the multiple prescriptions of hypnotic drugs in a university outpatient in Japan

Abstract Aims In Japan, the daily dosage of hypnotic drugs for insomnia treatment is increasing year by year, and over‐dependence on treatment with hypnotic drugs is a major problem. This study aimed to examine the factors related to the elimination of prescriptions of three or more hypnotic drugs within 1 year in our clinic. Methods We conducted two surveys. Survey ① assessed the frequency of prescriptions of three or more hypnotic drugs by retrospectively reviewing the medical records of all patients who visited general and psychiatric outpatient clinics from January 2013 to March 2019. Survey ② assessed changes in prescriptions of hypnotic and psychotropic drugs within the subsequent year by retrospectively reviewing the medical records of all patients prescribed three or more hypnotic drugs who visited neuropsychiatric outpatient clinics multiple times between April 2013 and March 2019. Results The frequency of prescribing three or more hypnotic drugs was six to nine times higher in psychiatry than in other departments. Flunitrazepam and brotizolam were the most common drugs prescribed and had the second lowest discontinuation rate after zolpidem. Conversely, eszopiclone, zopiclone, and suvorexant had the highest discontinuation rates. The success factors for drug reduction were age (odds ratio [OR]: 0.97, p < 0.0037), trazodone addition (OR: 12.86, p < 0.0194) and number of years of psychiatric experience. Conclusions The characteristics and success factors in relation to drug reduction in patients with multiple prescriptions of hypnotic drugs identified in this study may contribute to solving the problem of multiple prescriptions of hypnotic drugs

High rebound mattress toppers facilitate core body temperature drop and enhance deep sleep in the initial phase of nocturnal sleep

<div><p>Recently, several new materials for mattresses have been introduced. Although some of these, such as low rebound (pressure-absorbing/memory foam) and high rebound mattresses have fairly different characteristics, effects of these mattresses on sleep have never been scientifically evaluated. In the current study, we have evaluated effects of a high rebound mattress topper [HR] on sleep and its associated physiology, and the effects were compared to those of a low rebound mattress toppers (LR) in healthy young (n = 10) and old (n = 20) adult males with a randomized, single-blind, cross over design. We found that sleeping with HR compared to LR induced a larger decline in core body temperature (CBT) in the initial phase of nocturnal sleep both in young (minimum CBT: 36.05 vs 36.35°C) and old (minimum CBT: 36.47 vs. 36.55°C) subjects, and declines in the CBT were associated with increases in deep sleep/delta power (+27.8% in young and +24.7% in old subjects between 11:00–01:00). We also found significantly smaller muscle activities during roll over motions with HR (-53.0 to -66.1%, depending on the muscle) during a separate daytime testing. These results suggest that sleeping with HR in comparison to with LR, may facilitate restorative sleep at the initial phase of sleep.</p></div

Muscle activity needed to generate a rolling over motion on HR and LR mattress (Roll over evaluations).

<p>Significantly smaller muscle activity (i.e., integrated EMG) was needed to roll over on HR than on LR mattress in 3 out of 4 muscles measured (*p<0.05 by Student’s t-test).</p

High rebound mattress toppers facilitate core body temperature drop and enhance deep sleep in the initial phase of nocturnal sleep - Fig 1

<p>(A) Changes in core body temperature during sleep with HR and LR in young adult males (study I). Larger and longer lasting decrease in core body temperature (CBT) was seen in the initial half of the sleep period with HR (p<0.05 by topper type, p<0.01 by time, p<0.01 by topper type x time, repeated measures ANOVA with a grouping factor). (B) EEG delta power changes across the night (study I). Larger delta-power was observed with HR between 23:00–04:00 (p<0.01 by topper type, p = 0.22 by time, p<0.05 by topper type x time, repeated measures ANOVA with grouping factor).</p

High rebound mattress toppers facilitate core body temperature drop and enhance deep sleep in the initial phase of nocturnal sleep - Fig 2

<p>(A) Changes in core body temperature during sleep with HR and LR in old adult males (study II). As observed in younger subjects (Fig 2), larger decline in core body temperature (CBT) was observed with HR between 23:00–03:00 in old subjects (p<0.01 by topper type, p<0.02 by time, p<0.01 by topper type x time, repeated measures ANOVA with grouping factor). (B) EEG delta power changes across the night (study II). Larger delta-power was observed with HR between 23:00–03:00 (p<0.01 by topper type, p = 0.23 by time, p<0.05 by topper type x time, repeated measures ANOVA with grouping factor).</p

Comparisons of sleep and sleep-related parameters between HR and LR mattress topper use (study II).

<p>Comparisons of sleep and sleep-related parameters between HR and LR mattress topper use (study II).</p

Comparisons of sleep and sleep-related parameters between HR and LR mattress topper use (study I).

<p>Comparisons of sleep and sleep-related parameters between HR and LR mattress topper use (study I).</p