Withdrawal from long-term use of zopiclone, zolpidem and temazepam may improve perceived sleep and quality of life in older adults with primary insomnia

Long-term use of benzodiazepines or benzodiazepine receptor agonists is widespread, although guidelines recommend short-term use. Only few controlled studies have characterized the effect of discontinuation of their chronic use on sleep and quality of life. We studied perceived sleep and quality of life in 92 older (age 55-91 years) outpatients with primary insomnia before and after withdrawal from long-term use of zopiclone, zolpidem or temazepam (BZDA). BZDA was withdrawn during 1 month, during which the participants received psychosocial support and blindly melatonin or placebo. A questionnaire was used to study perceived sleep and quality of life before withdrawal, and 1 month and 6 months later. 89 participants completed the 6-month follow-up. As melatonin did not improve withdrawal, all participants were pooled and then separated based solely on the withdrawal results at 6 months (34 Withdrawers. 55 Nonwithdrawers) for this secondary analysis. At 6 months, the Withdrawers had significantly (P <0.05) shorter sleep-onset latency and less difficulty in initiating sleep than at baseline and when compared to Nonwithdrawers. Compared to baseline, both Withdrawers and Nonwithdrawers had at 6 months significantly (P <0.05) less fatigue during the morning and daytime. Stress was alleviated more in Withdrawers than in Nonwithdrawers (P <0.05). Satisfaction with life and expected health 1 year later improved (P <0.05) in Withdrawers. In conclusion, sleep disturbances, daytime fatigue and impaired quality of life may resolve within 6 months of BZDA withdrawal. These results encourage withdrawal from chronic use of benzodiazepine-type hypnotics, particularly in older subjects.Peer reviewe

Non-graduation after comprehensive school, and early retirement but not unemployment are prominent in childhood cancer survivors—a Finnish registry-based study

Survivors had higher frequencies than controls for lacking further education after comprehensive school. Unemployment was not common, but risk for early retirement was significantly increased in each three survivor group.</p

Miten vieroittaa iäkäs potilas unilääkkeestä?

Hoito­suo­si­tusten vas­tainen bentso­diat­se­piinien pitkäai­kais­käyttö uni­lääk­keenä on yleistä, ja sii­hen liit­tyy mo­nia ris­kejä var­sinkin iäk­käille henki­löille. Asteit­tainen, tuet­tu vie­roitus tuot­taa par­haat tu­lokset. Vieroi­tuksen oh­jaus on mahdol­lista to­teuttaa myös terveys­kes­kuksen vastaa­not­to­käyn­neillä. An­noksen pienen­nys­nopeus so­vitaan yh­dessä po­tilaan kans­sa, ja on esi­mer­kiksi 10–25 % 1–3 vii­kon vä­lein. An­noksen pienen­tä­miseen liit­tyy usein ns. rebound-unet­to­muutta, jol­loin oi­reet pa­laavat voimis­tu­neina. Täs­tä kan­nattaa infor­moida poti­lasta ja ker­toa, et­tä il­miö on ohi­me­nevä.Peer reviewe

Unilääkevieroituksesta saatiin hyviä tuloksia Satauni-projektissa

Yleis­lää­kärin ja sairaan­hoi­tajan psy­ko­so­siaa­linen tu­ki aut­toi ikään­tyviä poti­ laita vieroit­tumaan pitkäai­kai­sesta uni­lääk­keiden käy­töstä. Terveys­kes­kuk­sessa toteu­ tettu vie­roitus pa­ransi ikään­tyvien poti­laiden lihas­voimaa ja tasa­painoa, mut­ta kogni­ tii­viset ky­vyt ei­vät paran­tuneet

Pohjavesien suojelun ja kiviaineshuollon yhteensovittaminen - Satakunnan loppuraportti

Julkaisu sisältää erillisinä tiedostoina liitekartat: - Kartta 1: Satakunnan maa- ja kallioperän kiviainesvarat - Kartta 2: Satakunnan luokitellut pohjavesialueet, NATURA-alueet sekä luonnon- ja maisemansuojelullisesti arvokkaat harjualueet - Kartta 3: POSKI-luokitellut geologiset muodostumat ja pohjavesialueet Satakunnass

Long-term persistence of withdrawal of temazepam, zopiclone, and zolpidem in older adults: a 3-year follow-up study

Background: Studies on persistence of benzodiazepine agonist (BZDA) withdrawal in older outpatients are few, and few studies on long-term persistence over years have yet been published. To describe the persistence of temazepam, zolpidem, and zopiclone (BZDA) withdrawal among older outpatients at 3 years from the beginning of withdrawal, as well as any changes in use of other medications.Methods: 92 outpatients (>= 55 years) with primary insomnia, long-term BZDA use as hypnotics (mean duration of BZDA use 9.9 +/- 6.2 years), and willingness to withdraw from BZDAs each received either melatonin or a placebo nightly for one month. During this period, BZDAs were meant to be gradually withdrawn. Sleep hygiene counselling and psychosocial support were provided. Three years later, use of BZDAs and other medications was determined by interview and confirmed from medical records.Results: Of the original 92 outpatients, 83 (90%) participated in the 3-year survey (mean follow-up 3.3 +/- 0.2 years). The number of BZDA-free participants decreased from 34 (37%) at 6 months to 26 (28%; intention-to-treat) at 3 years, that of irregular BZDA users decreased from 44 (48%) at 6 months to 27 (29%) at 3 years, while that of regular users increased from 11 (12%) at 6 months to 30 (33%) at 3 years (P = 0.001). Those who were regular BZDA users at 3 years had at baseline (before withdrawal) higher BMI (P = 0.001) than did other participants. At 3 years, the total number of medications remained unchanged for non-users (P = 0.432), but increased for the irregular (P = 0.011) and regular users (P = 0.026) compared to baseline. At 3 years, compared to baseline, use of antidepressants, dopamine agonists, melatonin, and NSAIDs/paracetamol was significantly more common in the whole cohort, but their use did not differ between the BZDA-user subgroups. Randomization to melatonin or placebo during BZDA withdrawal was unrelated to BZDA-withdrawal result.Conclusions: At 3 years after withdrawal, the number of BZDA-free participants had decreased, but still one-third of the subjects remained BZDA-free, and one-third had reduced their use. Successful BZDA withdrawal did not lead to any increase in total number of medications; use of symptomatic medications in the whole cohort, however, did increase

Long-term persistence of withdrawal of temazepam, zopiclone, and zolpidem in older adults : a 3-year follow-up study

Background: Studies on persistence of benzodiazepine agonist (BZDA) withdrawal in older outpatients are few, and few studies on long-term persistence over years have yet been published. To describe the persistence of temazepam, zolpidem, and zopiclone (BZDA) withdrawal among older outpatients at 3 years from the beginning of withdrawal, as well as any changes in use of other medications. Methods: 92 outpatients (>= 55 years) with primary insomnia, long-term BZDA use as hypnotics (mean duration of BZDA use 9.9 +/- 6.2 years), and willingness to withdraw from BZDAs each received either melatonin or a placebo nightly for one month. During this period, BZDAs were meant to be gradually withdrawn. Sleep hygiene counselling and psychosocial support were provided. Three years later, use of BZDAs and other medications was determined by interview and confirmed from medical records. Results: Of the original 92 outpatients, 83 (90%) participated in the 3-year survey (mean follow-up 3.3 +/- 0.2 years). The number of BZDA-free participants decreased from 34 (37%) at 6 months to 26 (28%; intention-to-treat) at 3 years, that of irregular BZDA users decreased from 44 (48%) at 6 months to 27 (29%) at 3 years, while that of regular users increased from 11 (12%) at 6 months to 30 (33%) at 3 years (P = 0.001). Those who were regular BZDA users at 3 years had at baseline (before withdrawal) higher BMI (P = 0.001) than did other participants. At 3 years, the total number of medications remained unchanged for non-users (P = 0.432), but increased for the irregular (P = 0.011) and regular users (P = 0.026) compared to baseline. At 3 years, compared to baseline, use of antidepressants, dopamine agonists, melatonin, and NSAIDs/paracetamol was significantly more common in the whole cohort, but their use did not differ between the BZDA-user subgroups. Randomization to melatonin or placebo during BZDA withdrawal was unrelated to BZDA-withdrawal result. Conclusions: At 3 years after withdrawal, the number of BZDA-free participants had decreased, but still one-third of the subjects remained BZDA-free, and one-third had reduced their use. Successful BZDA withdrawal did not lead to any increase in total number of medications; use of symptomatic medications in the whole cohort, however, did increase.Peer reviewe