The effect of Temazepam on respiration in elderly insomniacs with mild sleep apnea

Division of Geriatric Medicine, Medical College of Virginia/Virginia Commonwealth University, USA.
Sleep (Impact Factor: 4.59). 11/1995; 18(8):644-5.
Source: PubMed


This study evaluated the respiratory effect of temazepam in elderly subjects (mean age 65 +/- 3.8 years), with mild sleep apnea. The 15 subjects of this report were enrolled in a larger randomized trial comparing pharmacological and behavioral treatments for insomnia. Seven subjects received temazepam 15-30 mg/day either alone or in combination with behavior therapy, and eight subjects received placebo or behavior therapy. The mean baseline respiratory disturbance index (RDI) was 9.2 +/- 2.8 for the nondrug and 8.8 +/- 5.3 for the temazepam group. There were no significant time, group or interaction effects. There was no increase in the RDI in elderly subjects with mild respiratory apnea receiving 15-30 mg of temazepam.

18 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Anxiety and insomnia are among the more frequently encountered problems in geriatric cases. The effective clinical approach identifies underlying diagnostic syndromes or general medical conditions. An integrated approach to management combines pharmacotherapy and behavioral interventions as appropriate. Overall the prognosis for most patients is excellent.
    Psychiatric Clinics of North America 04/1997; 20(1):137-64. DOI:10.1016/S0193-953X(05)70398-1 · 2.13 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Die Arbeit fa\t beschriebene Änderungen des Schlafes und der nächtlicher Atmung für 43 Medikamente zusammen, die bei Patienten mit schlafbezogenen Atmungsstörungen (SBAS) geprüft wurden. Zum Teil wurde eine Besserung der SBAS gesehen, diese war aber in der Regel klinisch unbedeutend oder konnte in anderen Studien nicht nachvollzogen werden. Die Ursache hierfür ist wahrscheinlich eine erhebliche Nacht-zu-Nacht-Variabilität der Zahl nächtlicher Atempausen. Lediglich für Patienten mit der Kombination Herzinsuffizienz/schlafbezogene Atmungsstörung scheint eine medikamentöse Therapie mit Theophyllin oder nächtlicher Gabe von Sauerstoff sinnvoll. Zukünftige Untersuchungen und Bewertungen von Medikamenten sollten die Nacht-zu-Nacht-Variabilität unbedingt mit einbeziehen. 43 different drugs have been found in studies on medical treatment of sleep apnea syndromes. The results are inconsistent, sometimes a decrease of the severity of sleep disordered breathing could be reported. We assume that the high night-to-night variability of sleep disordered breathing which was not considered in the various studies is responsible for the outcome. However oxygen or theophylline could be proven as effective in cases of congestive heart failure and central sleep apnea. Further studies on pharmacologic therapy have to include data about the night-to-night variability.
    Somnologie - Schlafforschung und Schlafmedizin 05/1998; 2(2):77-88. DOI:10.1007/s11818-998-0012-1
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hypnosedatives are used extensively in older people, although their usage has fallen since the early 1970s. Increasing consumer concerns now risk underuse of these drugs, even in appropriate situations. High quality prescribing of hypnosedatives requires consideration of the pharmacokinetics and pharmacodynamics of these drugs, an understanding of their adverse effects, efficacy and clinical situations in which they may be of use, and an appreciation of the role of nonpharmacological therapy. If these issues are adequately addressed, hypnosedatives can be used effectively to treat insomnia and some anxiety disorders. Hypnosedative prescribing can be improved through regular audits, and the development of a local prescribing policy and educational programmes.Benzodiazepines are the most commonly used hypnosedatives. They are used for the treatment of both insomnia and anxiety disorders, but can be associated with a number of adverse effects in older individuals including confusion, falls and fractures (particularly agents that have a long elimination half-life) and injurious car crashes. Increased mortality has also been reported in older individuals taking these drugs. Tolerance and dependency are concerns with poor prescribing of all benzodiazepines and withdrawal effects can be extreme when there is inappropriate clinical management of the cessation of very short half-life agents.Zopiclone and zolpidem are nonbenzodiazepine agents but they bind to the same receptors as benzodiazepines. They are used for the treatment of insomnia, and may be better tolerated than benzodiazepines in some older people.Other hypnosedatives, such as melatonin, chloral hydrate and chlormethiazole, are less suitable for the treatment of insomnia in older patients, but may be considered. Buspirone and antidepressants are specifically indicated in some anxiety disorders, but are generally not first-line hypnosedatives. Antipsychotics should not be used as hypnosedatives.Individual drug choice is affected by consideration of speed of onset, withdrawal effects, half-life and hangover effects, efficacy data and cost. Initial dosages should be low, and increases made slowly. Duration of therapy should generally be limited to 2 weeks in the first instance. It is often appropriate to withdraw hypnosedatives in long term users and this may be assisted by substituting short half-life agents with those that have a longer half-life.
    CNS Drugs 03/1999; 11(4):263-279. · 5.11 Impact Factor
Show more