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Vol 36 No. 1 - Psychiatry Updates
Administrative guidelines in insomnia
The Singapore Family Physician
Vol 36
No 1
- Psychiatry Updates
15
- 18
1 March 2010
0377-5305
The Administrative Guidelines in insomnia require the benzodiazepine prescriber to comply with three tasks – (1) Document & keep medical records, (2) use
benzodiazepines appropriately, and (3) make specialist referrals when indicated. To use benzodiazepines appropriately the following questions need to be answered: In acute insomnia – Do you use sleeping pills sparingly: 2-4 weeks, 1 night in 2-3 nights, lowest dose and shortest duration? In chronic insomnia – Do you use non-pharmacological therapies, practice the rule of no repeat without clinical review, check for abuse and dependence, and consider withdrawal therapy. In depression, pain disorder, schizophrenia – Do you know that you should not use sleeping pills as monotherapy? In anxiety – Do you limit benzodiazepine use to short term relief (2-4 weeks only)? In the elderly – Do you practice the following rules – use non-pharmacological interventions, one half to one quarter dose of adult dose, warn of cognitive impairment and fracture risk in long term use, and withdraw gradually as this may produce improvement in cognitive functions? Benzodiazepines dependence – Is the continued need for benzodiazepines due to dependence? Should you consider benzodiazepine withdrawal for the patient?