Table 1.

Step-by-Step Hypnotic Discontinuation Program in Chronic Long-Term Users

Steps to Taper Hypnotic Medications	Procedure
Plan the whole process: Physician and patient plan the discontinuation process over the following weeks in a collaborative fashion.	Assess regular daily dosage used. Stabilize dosage if needed. When patients use more than one hypnotic, stabilize dosage on only one drug (1 to 2 weeks). Estimate total number of weeks required to complete withdrawal if medication is decreased by 25% every other week. A written plan can be given out to the patient as a worksheet to increase adherence.
Gradual taper	Decrease daily intake by 25% of initial dosage for two weeks. Repeat this step, until the smallest dosage is reached.
Hypnotic-free nights are gradually introduced	In the first week, it may be best to pre-select nights associated with apprehension regarding next day's functioning. Increase number of those hypnotic-free nights in the second week.
Use on pre-determined nights	Pre-select nights regardless of next day's activities or anticipations. Strongly encourage observance to the initial plan, give rationale.
Complete discontinuation. Plan follow-ups to assess maintenance and prevent relapse	Assess patient's anxiety regarding complete cessation and go over coping strategies. Remind the patient that the minimal dosage used in the last weeks likely had few objective effects on their sleep.