The long and the short of sleeping pills

Article Abstract:

One-third of all adults are likely to have insomnia at some time during a given one-year period. About 17 percent of adults have serious insomnia; the condition is particularly common among women, the elderly, and people under psychological stress or with psychiatric disorders or substance abuse problems. Insomnia of short duration is almost always due to stress, but insomnia lasting weeks or longer may be due to a variety of different conditions, including medical illness, substance abuse, psychiatric disorders, and other conditions. When dealing with a patient whose insomnia has lasted more than three weeks or so, it is important to determine the underlying contributing factors and tailor the treatment to the individual needs of the patient. The introduction of benzodiazepine drugs in the late 1960s marked a great advance over older drugs such as barbiturates for the treatment of insomnia. However, it became clear that the benzodiazepines had their own drawbacks. While benzodiazepines were less likely to cause drug dependence than barbiturates, they had adverse effects on thought processes, coordination, and memory. These effects were considered to be related to the long time the benzodiazepines required to be metabolized and eliminated by the body. Therefore, when newer benzodiazepines which were eliminated more quickly were introduced in the mid-1970s, they were enthusiastically accepted. One such drug, triazolam, is now the most commonly prescribed hypnotic drug, or "sleeping pill", in the United States. Some problems remain, however. In the June 13, 1991 issue of The New England Journal of Medicine, Greenblatt and colleagues demonstrate that elderly patients metabolize triazolam more slowly than do younger patients. As a result, older patients have larger amounts of the drug in their bloodstream than do younger patients when given the same dose. The researchers suggest that elderly patients should receive about half the normal dose of this drug. Ironically, the story of hypnotic drugs is one of both excess and insufficiency. A few patients are probably taking too much, and nightly treatment should not continue for more than two to four weeks. However, many more patients, perhaps as many as 85 percent of all patients with serious insomnia, are not receiving any drug therapy at all, not even with over-the-counter medications. Many people remain untreated who might greatly benefit from these drugs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Drug therapy, Insomnia, Sleep disorders, Hypnotics and sedatives, Hypnotics, Triazolam, editorial, Central nervous system depressants

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A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure

Article Abstract:

An intervention program for elderly patients with congestive heart failure may reduce the likelihood of readmission to the hospital and improve quality of life. A total of 142 hospital patients older than 70 years with congestive heart failure were enrolled in an intervention program and compared to 140 similar patients who were not enrolled. The program consisted of education about congestive heart failure, prescription of a diet, analysis of medications, social-service support, and rigorous follow-up. Survival for 90 days without hospital readmission occurred in 64% of the intervention group and 54% of the control group. The total number of days of hospitalization was 556 in the intervention group, but 865 in the control group. Scores on a quality of life questionnaire improved by an average of 22 points in the intervention group and 11 points in the control group. The overall cost of care was approximately $460 less per patient in the intervention group.

Care and treatment, Congestive heart failure

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