Hyperarousal in insomnia and hypnotic dose escalation

Publication date: Available online 6 July 2016
Source:Sleep Medicine
Author(s): T.A. Roehrs, T. Roth
BackgroundGiven concern regarding the abuse liability of hypnotics this study assessed hyperarousal in people with insomnia and its relation to hypnotic self-administration over 12 months of nightly hypnotic use.MethodsNinety-five subjects with insomnia, 32-64 yrs old, received a screening nocturnal polysomnogram (NPSG) and Multiple Sleep Latency Test (MSLT) the following day and were randomized to take zolpidem 10 mg or placebo nightly for 12 months. During months 1 and 8, while taking their prescribed medications, NPSGs and MSLTs were conducted and urine was collected (0700-1500 hr) and analyzed for norepinephrine (NE) levels. A subset (n=54) underwent hypnotic self-administration assessments in months 1, 4, and 12.ResultsMean daily sleep latency on the screening MSLT was distributed across the full range of MSLT latencies (2-20 min). Those with the highest screening MSLT latencies had the higher NE levels compared to those with the lowest MSLT latencies. In the subset undergoing the self-administration assessment those with the highest MSLT latencies chose more capsules (placebo and zolpidem) and increased the number of capsules chosen in months 4 and 12 relative to month 1 compared to those with the lowest MSLT latencies.ConclusionsThese data show that some insomniacs are hyperaroused with high MSLT/NE levels and compared to low MSLT/NE insomniacs, they increase the number of capsules (zolpidem and placebo) self-administered on months 4 and 12 relative to month 1.



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