Table 1.
Benzodiazepine (BZD) use for treatment of insomnia
| Insomnia | |||||
|---|---|---|---|---|---|
| Study | N | Age | BZD/Other Treatment | Summary of Findings | Favors BZD |
| Placebo Controlled | |||||
| Glass et al. 200821 | 20 | Mean 73.9 Range 70–89 |
Temazepam 15 mg Diphenhydramine 50 mg Placebo |
Sleep improvements greater with temazepam versus placebo and diphenhydramine | Yes, temazepam was more effective but advantage is mitigated by risk of falls |
| Morin et al. 199930 | 78 | Mean 65 | Temazepam 7.5 to 30 mg CBT Temazepam + CBT Placebo |
Three active treatments were more effective than placebo. Improvements in sleep favored combination treatment, then CBT, followed by pharmacotherapy. | Yes, pharmacologic approaches are effective but sleep improvements are better sustained with CBT |
| Leppik et al. 199722 | 335 | Range 60–85 | Triazolam 0.125 mg Temazepam 15 mg Zolpidem 5 mg Placebo |
Compared to placebo sleep latency improved with zolpidem and temazepam (not triazolam). Sleep latency shorter than placebo in temazepam group. Temazepam and triazolam had significantly more side effects. | Yes, but potentially offset but side effects (drowsiness, fatigue, nervousness) |
| Roth et al. 199761 | 30 | Mean 66 | Quazepam 7.5 to 15 mg Placebo |
Improved total sleep time and sleep latency versus placebo | Yes |
| Roger et al. 199362 | 205 | Mean 80 Range 60–90 |
Triazolam 0.25 mg Zolpidem 5 to 10 mg Placebo |
Both groups favored treatment, no difference between triazolam and zolpidem | Yes |
| Elie et al. 199063 | 44 | Mean 76 Range 60–90 |
Triazolam 0.125 or 0.25 mg Zopiclone 5 or 7.5 mg Placebo |
Both drugs more effective than placebo | Yes |
| Overstall & Oldman 198764 | 62 | Mean 82 Mean 80 Mean 80 |
Lormetazepam Chlormethiazole Placebo |
Both improved sleep duration, sleep latency, improved quality of sleep | Yes |
| Klimm et al. 198723 | 74 | Mean 73 | Nitrazepam 5 mg Zopiclone 7.5 mg Placebo |
Improvements in sleep quality and latency over placebo for both nitrazepam and zopiclone | Yes, but improvements with nitrazepam were offset by more side effects |
| Bayer & Pathy 198665 | 89 | Range 67–89 | Loprazolam 0.5 or 1 mg Placebo |
Improved sleep latency, satisfaction with sleep, decreased number of nocturnal awakenings with loprazolam | Yes |
| Viukari et al. 198466 | 29 | Mean 81 Range 62–98 |
Brotizolam 0.125 mg Nitrazepam 2.5 mg Placebo |
Both better than placebo | Yes |
| Vogel 198467 | 10 | Mean 60 Range 55–71 |
Lormetazepam 0.5 mg Placbo |
Improved total sleep time and sleep latency over placebo | Yes |
| Viukari et al. 198368 | 37 | Mean 74 | Flunitrazepam 1 mg Nitrazepam 5 mg Placebo |
Both BZDs were more effective in inducing and maintaining sleep | Yes |
| Elie et al. 198369 | 30 | Mean 75 Range 60–93 |
Flurazepam 15 mg Zopiclone 5, 7.5, and 10 mg Placebo |
Both active groups better than placebo, flurazepam and zopiclone equally effective | Yes |
| Martinez & Serna 198270 | 60 | Range 54–90 | Quazepam 15 mg Placebo |
Improved quantity and quality of sleep with benzo | Yes |
| Caldwell 198271 | 57 | Range 60–81 | Quazepam 15 mg Placebo |
Improved sleep measures for BZD | Yes |
| Fillingim 198272 | 75 | Mean 81 | Temazepam 30 mg Flurazepam 30 mg Placebo |
Both better than placebo in improving quality of sleep | Yes |
| Piccione et al. 198073 | 27 | Mean 70 Range 60–94 |
Triazolam 0.25 or 0.5 mg Chloral hydrate 250 or 500 mg Placebo |
Triazolam improved sleep over placebo and chloral hydrate | Yes |
| Frost & DeLucchi 197974 | 6 | Range 67–82 | Flurazepam 15 mg Placebo |
Improved sleep latency and total sleep time with BZD | Yes |
| Goldstein et al. 197875 | 17 | Mean 82 | Oxazepam 15 mg Flurazepam 15 mg Chloral hydrate 500 mg Placebo |
Only oxazepam was better than placebo in reducing nighttime awakenings and improved quality of sleep. Flurazepam was better than placebo in decreasing sleep latency although had residual daytime sedative effect. | Yes |
| Reeves 197776 | 41 | 69 70 70 Range 61–83 |
Triazolam 0.25 mg Flurazepam 15 mg Placebo |
Triazolam better than placebo in sleep onset, duration of sleep, nighttime awakenings, and feeling restless. Flurzepam was better than placebo in onset of sleep and quality of sleep. Triazolam out performed flurazepam in all measures | Yes |
| Mamelak et al. 198977 | 36 | Range 60–72 | Brotizolam 0.25 mg Flurazepam 15 mg Placebo |
Sleep improved with all treatments, at end of the study only placebo treated group was sleeping significantly longer | No |
| Meuleman et al. 198778 | 17 | Mean 78 Range 56–97 |
Temazepam 15 Diphenhydramien 50 mg Placebo |
Diphenhydramine and temazepam resulted in decreased sleep latency than placebo, longer duration of sleep with diphenhydramine versus temazepam, more deficits on neurologic functioning with temazepam | No |
| Vs. Other Treatment | |||||
| Lachnit et al. 198325 | 46 | Mean 77 Range 54–90 |
Midazolam 15 mg Vesparax (hydroxyzine 50 mg, brallobarbital 50 mg, and secobarbital 150 mg) |
Identical in terms of efficacy, greater side effects with Vesparax | Yes |
| Dehlin et al. 199579 | 102 | Mean 79 | Flunitrazepam 1 mg Zopiclone 5 mg |
No difference in effectiveness between groups | No |
| Bayer et al. 198680 | 53 | Mean 82 Range 70–91 |
Triazolam 0.125 mg Chlormethiazole 384 |
Similar hypnotic effect during early phase, results not sustained by triazolam. Worse daytime withdrawal effects with triazolam | No |