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Sleep Med. 2015 Sep;16(9):1160-8. doi: 10.1016/j.sleep.2015.06.015. Epub 2015 Jul 7.

Durability of treatment response to zolpidem with three different maintenance regimens: a preliminary study.

Author information

1
Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA; School or Nursing, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: mperlis@upenn.edu.
2
Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
3
Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
4
Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
5
Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; Mood and Anxiety Disorders Treatment and Research Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
6
Department of Psychology, University of Arizona, Tucson, AZ, USA.
7
Department of Psychiatry, University of Rochester, Rochester, NY, USA.

Abstract

BACKGROUND AND AIM:

At present, there is no consensus regarding how to medically manage chronic insomnia in the long term. The unstated standard of practice is for patients to use hypnotics intermittently. The present study aimed to compare a partial reinforcement strategy with nightly and intermittent dosing strategies for its potential as a maintenance therapy.

METHODS:

A mixed model was used in the study. One between-subjects factor: group (n = 4). One repeated-measures factor: time (12 weekly assessments). A total of 74 subjects with chronic Insomnia were treated with 10 mg zolpidem for 4 weeks. Treatment respondents were randomized to nightly dosing with 10 mg or 5 mg (QHS-10 and QHS-5), intermittent dosing with 10 mg (IDS-10 [3-5 days weekly]), or partial reinforcement dosing with 10 mg (PRS-10 [nightly pill use with 50% active medication and 50% placebos]) for 12 weeks.

RESULTS:

It was found, in compliant subjects (n = 55), that all four strategies evaluated maintained treatment response over time (ie, prevented or delayed relapse). For the subjects that remained in remission, the subjects in the intermittent dosing group (IDS-10) group exhibited poorer sleep continuity.

CONCLUSIONS:

While best considered a preliminary study, the present findings suggest that the partial reinforcement strategy may be a viable means toward maintaining treatment gains over time with less active medication.

KEYWORDS:

Insomnia; Maintenance therapy; Partial reinforcement; Placebos; Zolpidem

PMID:
26298795
PMCID:
PMC4709332
DOI:
10.1016/j.sleep.2015.06.015
[Indexed for MEDLINE]
Free PMC Article

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