Journal of Sleep Disorders: Treatment and CareISSN: 2325-9639

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Research Article, J Sleep Disor Treat Care Vol: 5 Issue: 1

Pharmacotherapy for Chronic Insomnia: A Brief Survey of PCP Attitudes and Preferences

Sorscher AJ1,3*, Siddiqui AA2, Olson A3 and Johnson D4
1Medical Director of the Sleep Health Center at Alice Peck Day Memorial Hospital, Lebanon
2Dartmouth College, Hanover, NH 03755, USA
3Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, New Hampshire, USA
4Department of Pediatrics, Geisel School of Medicine at Dartmouth, New Hampshire, USA
Corresponding author : Sorscher JA, MD
Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, The Sleep Health Center, Alice Peck Day Memorial Hospital, 18 Old Etna Road, Lebanon, NH 03766
Tel: 603-650-4000; 603-650-4170
E-mail: adam. [email protected]
Received: December 23, 2015 Accepted: March 02, 2016 Published: March 07, 2016
Citation: Sorscher AJ, Siddiqui AA, Olson A, Johnson D (2016) Pharmacotherapy for Chronic Insomnia: A Brief Survey of PCP Attitudes and Preferences. J Sleep Disor: Treat Care 5:1. doi:10.4172/2325-9639.1000169

Abstract

Purpose: To examine primary care professionals’ (PCP) attitudes and prescribing preferences toward hypnotic medications to treat chronic insomnia.
Methods: An online survey was sent to members of the Dartmouth CO-OP, a practice-based primary care research network in Maine, Vermont, and New Hampshire.  The survey begins with a case vignette of a 64-year old woman suffering from chronic insomnia.  Clinicians were then presented with eight questions about management of the patient and their attitudes toward prescribing medications, focusing on benzodiazepines/benzodiazepine receptor agonists (BDZ/BZRAs).
Results: 103 of 198 clinicians (52%) responded.  Regarding choice of medication for the case vignette, 81% of respondents preferred the off-label use of hypnotics such as trazodone or melatonin; 11% stated they would choose BDZs and 22% would choose BZRAs.  Strong majorities expressed that negative consequences would occur with use of BDZ/BZRAs, including tolerance (77%), dependence (68%), other side effects (53%), and addiction (51%). PCP preference for off- label prescribing was correlated to levels of concern about harms (addiction, dependence, tolerance, side effects) of BDZ/BZRAs as measured on a global medication risk score in this survey.  In addition, 14% of respondents felt that pharmacotherapy was not an appropriate therapeutic option for chronic insomnia in the case vignette.
Conclusion: Most of the clinicians surveyed acknowledged a legitimate role for hypnotic medications in chronic insomnia but expressed reservations toward BDZ/BZRAs despite their FDA-approval and proven efficacy.  There appears to be a gap between published guidelines for selection of sedative-hypnotic medications and PCP preferences. 

Keywords: Chronic insomnia; Benzodiazepines; Benzodiazepine receptor agonists; Primary care

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