Don't Fear Benzodiazepines for Sleep Problems. (Benadryl Called Ineffective)

By Kirn, Timothy F. | Clinical Psychiatry News, April 2003 | Go to article overview

Don't Fear Benzodiazepines for Sleep Problems. (Benadryl Called Ineffective)


Kirn, Timothy F., Clinical Psychiatry News


CHICAGO -- Physicians need to take their patients' sleep complaints more seriously and be careful about underprescribing medications such as benzodiazepines, Dr. Mark W Mahowald said at a clinical symposium sponsored by the American College of Rheumatology.

"There is not one shred of evidence that Benadryl is an effective sleep-inducing agent, said Dr. Mahowald, director of the Minnesota Regional Sleep Disorders Center, Minneapolis. "It makes people feel sleepy, but it has no effect on sleep. And the reason we prescribe it is because we are afraid of using the medications that do work."

The idea that physicians should be conservative when it comes to prescribing benzodiazepines mainly comes from the chemical dependency community, Dr. Mahowald said. That community has noted that people who abuse drugs often use benzodiazepines, therefore labeling them as drugs of abuse. But benzodiazepine abuse, tolerance, and rebound insomnia virtually never occur in the bona fide insomnia population, he said. "The fear of drug abuse has led instead to patient abuse."

Sleep in rheumatologic diseases, for example, has hardly been studied at all, although it makes sense that people with pain might have their sleep disturbed. Of the drugs used regularly by physicians, only two have definitively been tied to sleep problems: steroids, which can cause severe insomnia, and benzodiazepines.

Those patients who are on a potent cocktail of medications and complain of insomnia must be taken seriously Dr. Mahowald added. Those complaints should be examined, and sleep medication should be prescribed when appropriate. Here's what's known about the association of sleep and various rheumatic diseases:

* Fatigue is a common complaint of rheumatoid arthritis (RA) patients. This may be a primary manifestation of the disease, or it may be attributable to a sleep disorder associated with the discomfort. …

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