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Persistent Insomnia in Chronic Hypnotic Users Presenting to a Sleep Medical Center: A Retrospective Chart Review of 137 Consecutive Patients

Krakow, Barry MD*†‡; Ulibarri, Victor A. BS*†; Romero, Eddie BS*†

The Journal of Nervous and Mental Disease: October 2010 - Volume 198 - Issue 10 - p 734-741
doi: 10.1097/NMD.0b013e3181f4aca1
Original Articles

Chronic insomnia patients may fail pharmacotherapy. We reviewed charts on 137 chronic insomnia patients new to our sleep medical center who reported persisting insomnia despite long-term usage of pharmacotherapy. We examined 4 areas: (1) patient views on encounters with prescribing physicians; (2) self-reported medication efficacy; (3) treatment-seeking goals; and (4) completion of a sleep medicine workup. Insomnia chronicity averaged 13 years; use of prescription medication for sleep averaged 3.81 years. Encounters with prescribing physicians yielded few options beyond drugs. Drug efficacy was not optimal for most of these patients. Sleeping better or drug-free were their chief goals. Subjective and objective sleep measures confirmed moderately severe residual insomnia as well as fair to poor waking impairment and quality of life. Sleep workup revealed high rates of maladaptive behavioral influences (96%), psychiatric complaints (89%), and obstructive sleep apnea (71%). In chronic insomnia patients who failed pharmacotherapy, comorbid mental and physical factors indicated a sleep disturbance complexity unlikely to respond fully to medication.

*Sleep and Human Health Institute, Albuquerque, NM; †Maimonides Sleep Arts and Sciences, Ltd, Albuquerque, NM; and ‡Los Alamos Medical Center Sleep Laboratory, Los Alamos, NM.

Send reprint requests to Barry Krakow, MD, Sleep and Human Health Institute, 6739 Academy NE, Suite 380, Albuquerque, NM 87109. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.