Magic bullets for insomnia? Patients' use and experiences of newer (Z drugs) versus older (benzodiazepine) hypnotics for sleep problems in primary care

Br J Gen Pract. 2008 Jun;58(551):417-22. doi: 10.3399/bjgp08X299290.

Abstract

Background: Little is known about patients' perceptions of newer hypnotics.

Aim: To investigate use, experience, and perceptions of Z drug and benzodiazepine hypnotics in the community.

Design of study: Cross-sectional survey of general practice patients who had received at least one prescription for a Z drug or benzodiazepine in the previous 6 months.

Setting: Lincolnshire, UK.

Method: Self-administered postal questionnaire.

Results: Of 1600 surveys posted, 935 (58.4%) responses were received, of which 705 (75.4%) were from patients taking drugs for insomnia. Of those 705 patients, 87.9% (n = 620) were first prescribed a hypnotic by their GP, and 94.9% (n = 669) had taken a sleeping tablet for 4 weeks or more. At least one side effect was reported in 41.8% (n = 295); 18.6% wished to come off hypnotic medication; and 48.5% had tried to stop treatment. Patients on Z drugs were more likely to express a wish to stop (22.7% versus 12.3%; odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.13 to 2.49), or to have attempted to come off medication, than those on benzodiazepines (52.4% versus 41.0%; OR = 1.54, 95% CI = 1.12 to 2.12). The two groups did not differ significantly in respect of benefits or adverse effects.

Conclusion: There were no significant differences in patients' perceptions of efficacy or side-effects reported by those on Z drugs compared to patients taking benzodiazepines. Side-effects were commonly reported, which may have contributed to a high proportion of responders, particularly patients on Z drugs who were wishing to stop, or who had previously tried to stop taking this medication. Reported prescribing practices were often at variance with the licence for short-term use.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetamides / administration & dosage
  • Acetamides / adverse effects
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude to Health*
  • Azabicyclo Compounds / administration & dosage
  • Azabicyclo Compounds / adverse effects
  • Benzodiazepines / administration & dosage
  • Benzodiazepines / adverse effects
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage
  • Hypnotics and Sedatives / adverse effects*
  • Male
  • Middle Aged
  • Patient Satisfaction*
  • Piperazines / administration & dosage
  • Piperazines / adverse effects
  • Pyridines / administration & dosage
  • Pyridines / adverse effects
  • Pyrimidines / administration & dosage
  • Pyrimidines / adverse effects
  • Sleep Initiation and Maintenance Disorders / drug therapy*
  • Substance Withdrawal Syndrome / etiology*
  • Zolpidem

Substances

  • Acetamides
  • Azabicyclo Compounds
  • Hypnotics and Sedatives
  • Piperazines
  • Pyridines
  • Pyrimidines
  • zopiclone
  • Benzodiazepines
  • Zolpidem
  • zaleplon