Insomnia and psychotropic drug consumption

Pq.

NeumPsychophammoL

& B&L Psychfat

1995. Vol. 19. pp. 421-431

Copyright D 1995 Elsevler Science Ltd

Pergamon

Printed III Great Britain. AU rights reserved 0278 - 5846/95

$29.00

0278-5846(94)00023-2

INSOMNIA AND PSYCHOTROPIC

MAURICE

DRUG CONSUMPTION

M. OHAYON and MALIJAI CAULET

Centre de recherche - Institut Philippe Pine1 de Montreal, Montreal (Quebec), Canada (Final form, May 1994)

Ohayon, Maurice M. and Malijai Caulet: Insomnia and psychotropic Psychopharmacol. & Biol. Psychiat. 1995, 19(S): 421-431. 1.

2.

3. 4.

5. 6.

drug consumption.

Prog. Neuro-

During an epidemiological study conducted by telephone on sleep disorders in the metropolitan area of Montreal (Quebec, Canada), the authors found that 5% of subjects used psychotropic drugs. These drugs were usually prescribed by a general practitioner (72.9%). From this population, the authors drew three groups of subjects: users with sleeping difficulties (USD); non users with sleeping difficulties (NUSD) and, non users without sleeping difficulties (NUWSD). Results showed that the utilization of psychotropics was usually chronic and more frequent among the elderly and women. In multivariate models, when users were compared to NUWSD, the authors found eight variables significantly associated with psychotropic consumption: age (2 55), sex (female), presence of physical illness, medical consultation, dissatisfaction with sleep onset period and sleep quantity, sleep onset period greater than 15 minutes, and to never or rarely dream. When users were compared to NUSD, three variahles were found to he associated with psychotropic consumption: age, to he formerly married, and to experience regular nighttime awakenings. It appears that the utilization of psychotropic drugs does not increase the quality of sleep when consumers are compared to non treated insomniacs (NUSD) on parameters of sleep satisfaction.

Kevwords:

henzodiazepines,

epidemiology,

Ahhreviations: users with sleeping users without sleeping difficulties

insomnia,

psychotropics.

difficulties (USD), non users with sleeping difficulties (NUWSD), sleep onset period (SOP).

(NUSD), non

Introduction Consumption

of psychotropic

world. The prohlems authorities.

drugs is a widespread

related to the consumption

Many epidemiological

the hypnotic

7.7%; in Spain (Vazquez-Barquero 6.9% (tranquilizers

in the general population

and tranquilizers

studies have illustrated the importance

Among most recent studies of a general population, noted that in Great-Britain,

phenomenon

of hypnotics

of this consumption.

without regard to insomnia,

and anxiolytic

consumption

(1.9%), antidepressants

survey of 1987 showed that the hypnotic

and tranquilizer 421

(1.3%));

consumption

Dunhar et al. (1989)

for the last 12 month period, was

et al., 1989) the rate of actual consumption

(5.7%), hypnotics

across the

are worrying health care

of psychotropic

drugs was

in Quebec, the “Sante Quebec” was 5.3% (Laurier et al., 1990).

M. M. Ohayon and M. Caulet

422 In relation consumption

to insomnia

in the general

of hypnotics

at 2% in the Swedish population.

of psychotropic

drugs as treatment

(5%). and other psychotropics population

took hypnotic,

population,

for insomnia

and Nasman

(1991) established

In France (Ohayon,

symptoms

(0.4%)). Mellinger

anxiolytic

Allgulander

was 9.4% (hypnotics

(3.8%). anxiolytics

et al. (1985) found that 4.3% of the American

or antidepressant

the

19--), the consumption

drugs as a psychotherapeutic

adult

for sleep

medication

during the year prior to their survey. Disparities

observed

assessments

between

the countries

were not homogeneous

differences

between

(time intervals,

profession

modifying

of sleep disorders).

their perception

many characteristics

(education

of subjects

1991; Dunbar et al., 1989; Laurier et al., 1990; Mellinger

1) elderly

subjects

treatment,

prescriptions

Unfortunately,

are the greatest

effects

information

and insomniacs

drugs are well known. consumption 2) contrary

A

(Allgulander

et al., 1985), emphasizing

of this type of medication;

that:

to the rules of

about treatments

followed

consumers

of psychotropic

drugs who take

who do not take this type of medication.

survey about sleep disorders

drug consumption

of the physicians

are usually long-term.

little is known about what distinguishes

During an epidemiological psychotropic

consumers

of hypnotics

them for their hypnotic

collected

of hypnotic and anxiolytic

2) the

in the population

and formation

who are taking psychotropic

where

of information);

3) the cultural differences

of the population

number of authors have insisted on the importance and Nasman,

1) the studies themselves

type of drugs, sources

health care systems of these countries;

as well as in the medical

However,

are due to many factors:

and their consequences,

the authors have

by subjects. They aimed to identify the determinants

of

in this population.

Methods In 1993, an epidemiological by telephone

study on sleep habits and disorders

in the metropolitan

area of Montreal

(Quebec,

in a general population

was conducted

Canada).

Ponulation The population 1,761,121).

was composed

A representative

of French speaking people of the metropolitan

sample of 1723 subjects

was completed

persons (acceptance rate: 81.4%). Subjects were between sample was composed of 955 women and 768 men.

following

area of Montreal the solicitation

(about of 2117

15 and 100 years of age. The unweighted

Study Design The geographic

distribution

(1993). During the telephone person in the household

of the sample was drawn using the data provided contact, the Kish selection

by Statistics

Canada

method (Kish, 1965) was used to identify which

was to be interviewed.

Persons who had refused to participate a second time. A minimum

in the study on the first phone call were subsequently

of six calls with no answer was made before replacing

these calls were made at different

times of the day and week.

contacted

the phone number;

423

Psychotropic Drug Consumption and Insomnia

Excluded problem,

from the study were: persons

who had speech impediments,

Assessment

were performed

Eva1 (Ohayon,

sequence

who suffered

from a hearing

Instruments

All the interviews system

who did not speak French,

and those who were too sick to be interviewed.

by telephone

1994) which

of a series of questions

concerning:

the bed partner; hypnotics

III-R (APA, psychiatric

4) psychiatric

of sleep disorders

assessed

guided by the knowledge

evaluation.

The system

information;

the

2) medical consultations

and medical history; 5) quantity and quality

on a 15-item scale; 7) manifestations

(prescribed

or not); 10) treatment

associated

of drugs, alcohol and tobacco,

and 12) psychiatric

reported

by

1987), DSM-IV

(APA,

draft criteria

with hypnotics

classifications

and anxiolytics;

of sleep disorders

1993), ICD-IO (WHO,

11)

DSM-

1992), and 13) associated

disorders.

In this paper, the authors report sleeping habits and related problems to psychotropic The assessment medication

based

allowed

8) time at which the subject hopes to fall asleep and awaken; 9) present or past use of

or anxiolytics

consumption

homogeneous

1) sociodemographic

during the past 6 months; 3) treated illnesses; of sleep; 6) repercussions

by lay interviewers

permitted

of psychotropic

drug consumption

drug consumption.

was obtained through two questions:

“Do you take

that helps you sleep?” and “Do you take medication to reduce anxiety?” Following each of these

questions, the subject was asked to give the name and dosage of the drug in question, which kind of physician had prescribed

it as well as questions about associated treatments (name of the medication and instructions).

Data Analvses The data were weighted Results

are presented

to compensate

with weighted

undersampling

percentages

of men and disparities

and unweighted

n values.

between

Bivariate

carried out by means of Cramer’s V (3 x 2 Tables or 3 x 3 Tables) and Chi Square statistics Logistic regressions psychotropic

permitted

verification

of whether an observed

drugs and a variable can be explained

all other variables.

These models were calculated

as the dependent

variable.

The independent

association

with psychotropic

correlations

between

these independent

variables were significantly

associated

of INDICATOR

was used.

contributed interpreted

contrasts

less to the presence according

variables

variables.

with the presence

to these reference

of psychotropic

were selected

were

(2 x 2 Tables).

drug consumption

and, minimal

which categories

the reference

drug consumption.

of

this variable with

on the basis of a significant model

of psychotropic

For each variable,

of psychotropic

that maintained

in an univariate To determine

analyses

relation between the consumption

by the relations with the presence

drug consumption

age groups.

or absent

of the independent

drug consumption,

the method

category

was the one that

The significant

Odds ratios were

categories.

The prevalence of people dissatisfied with their sleep and/ or taking medication for sleeping difficulties was 17.8% (k 1.8%) of the population.

Dissatisfaction

paper by reference

with sleep quality and presence

to complaints

with sleep and sleeping difficulties

difficulty to initiate or maintain sleep, early morning awakenings,

of classical

are terms used in this

insomnia

and nonrestorative

sleep.

symptoms

like

M. M.

424

Psvchotronic

Ohayon and M. Caulet

Drup Consumntion

Sleen Enhancine Medication. Sleep enhancing population. However,

There was no significant

medication

difference

it was found that only 0.8% took an hypnotic,

drugs, and 0.7% other non psychotropic Among

these

subjects,

73.5%

were

was reported by 3.8% (k 0.9%) of the general

between men (2.8% + 1.1%) and women (4.7% f 1.4%). 2% an anxiolytic;

0.3% other psychotropic

drugs. dissatisfied

with their sleep

medication.

Most of those (83%) who took a sleep enhancing

dissatisfied

with their sleep without medication.

when

medication

they did not take their

for more than one year were

In the case of those who took their medication

less than

one year, half (54.9%, p < 0.05) are dissatisfied. Anterior

use of sleep enhancing

Anxietv Reducinr

Medication.

medication

was declared

The consumption

by 8.3% of the general population.

of anxiety

reducing

medication

(+ 0.8%) of the general population (29.7% of these subjects had no sleep difficulties).

was cited by 3%

There was a significant

difference between men (1.6% dz0.9%) and women (4.3% * 1.3%). After verification of the medication name, it was found that 1.6% took an anxiolytic, 0.8% other psychotropic

drugs and 0.6% other non psychotropic

drugs. Anterior

use of medication

Total Psvchotronic

to reduce anxiety was mentioned

Drug Consumntion.

When the results of the two questions

(each subject

being counted

psychotropic

drugs: 3.5% took an anxiolytic,

other psychotropic the consumed

above are combined

once), it is found that 5% (zh 1.0%) of the population

drugs (antidepressant,

drugs cannot be considered

The most frequently medication

by 5.5% of the general population.

0.9% an hypnotic,

normothymic

or neuroleptic).

as being psychotropic

utilized drug was lorazepam

actually

For about 1% of the population,

drugs.

for sleep enhancing effect as well as anxiety reducing

(Table 1). Table 1 Psychotropic

Drugs Repartition

Sleep enhancing medication (n=63) International Chemical Denomination Lorazepam Bromazepam Clonazepam Oxazepam Alprazolam Flurazepam Othersb

took real

0.1% took both drugs and 0.7% took

na

%a

20 4 4 4

32.7 5.7 5.7 5.2 1.6 4.5 50.3

: 27

a Unweighted n values and weighted rates bOthers contain drugs that appear only once

Anxiety reducing Medication (n=53) na 13 5 4 1 4 1 25

%a 27.1 9.6 7.3 1.8 7.3 3.0 43.9

Psychotropic

Drug Consumption

Age

Fig 1: Rates of psychotropic

consumption

For most cases, the psychotropic by a psychiatrist Subsequently, dissatisfaction

groups

according to sex and age groups

drug was prescribed

by a general practitioner

(72.9%). Prescription

was used in 13.9% of cases and 11.4% by a neurologist. three groups of subjects were defined considering

their psychotropic

consumption

and their

with their sleep. Each group was also divided according to two age groups (< 55 and 2 55):

1) non user group without sleeping 2) non user group with sleeping 3) user group with sleeping Twelve

425

and Insomnia

subjects

difficulties

difficulties

difficulties

were excluded

(NUWSD)

(n= 1395: 1102 < 55 and 293 2 55);

(NUSD) (n= 242: 210 < 55 and 32 2 55 );

(USD) (n = 74: 3 1 < 55 and 43 1 55).

from subsequent

analyses

because

they did not fit in any of these

groups. General Character& For most, psychotropic

drug consumption

was chronic: 75% had been using it for more than 6 months,

28.1% (k 9.8%) more than five years, 32.6% (+ 10.3%) between one and five years, and 14.3% (* 7.7%) between

6 months and one year. For 25.0% (* 9.5%) of cases, psychotropic

than 6 months.

Once more, chronic

use of psychotropics

Twice

as many women significantly

(6.7% * 1.6%) as men (3.1% f increased

16.7%; men: 10.1%).

(p < 0.05) used them. 1.2%) took a psychotropic

drug. This

with age. As can be seen in Fig. 1, the rates were nearly four times

higher in the group aged 55 and more. The highest consumption (women:

was less

was related to age: 88.4% of the older users

utilized them more than 6 months while 61.3% of the younger

consumption

drug consumption

is observed

among subjects over 65 years

426

M. M.

Sleeping difficulties

Ohayon and M. Caulet

alone were more frequent among younger subjects of the general population

older (< 55: 15.5%; 155:

8.6%~).

There was an association

between

the marital status and psychotropic

younger subjects where 32.9% of the USD were separated, of the NUWSD Medical

Consultation.

Medical consultation associated

older subjects

this association

Sleep Characteristics. 1) Complaint dissatisfaction

the presence

of physical

at any age (Table 2). While in the

of physical

illness was more frequent

among

sleep characteristics:

sleep duration was reported by a large percentage

of the two groups with

40.6% of the users (USD) and 47.6% of NUSD (vs 10.2% of NUWSD, p < 0.0001). This

was clearly higher among younger users than older (54.9% vs 3 1.5%, p < 0.05) (Table 2).

2) Non restorative

sleep was a frequent complaint

was also more important nighttime

between the two groups with sleeping

(at least once a night) concerned

half of the USD, a quarter of

and a third of NUSD (Table 2). While among users (USD), younger subjects

was more common respectively).

awakenings

older subjects,

age, 58% claimed

more

rate of nighttime

groups (32% vs 18.8% and 52.9% vs 32.9%

awakenings

was higher

to the NUWSD (52.9% vs 32%; p < 0.05). The type of nighttime

was then examined.

reported

than older subjects did (72.3% vs 40.8%). p < 0.05) this complaint

among older subjects of the two non-user

Among

difficulties:

to 27.4% of the NUWSD group (p < 0.0001). This

among younger users than older (62% vs 26.4%, p < 0.005) (Table 2).

awakenings

frequent regular nighttime

compared

to 9.5%

is not found in the user group.

40.3% of the USD and 52.5% of the NUSD, compared

NUWSD,

solely among

period and the presence

consumption

There were several significant

of unsatisfying

sleeping difficulties:

in the last 6-month

with psychotropic

two non user groups (NUSD and NUWSD),

3) Regular

consumption

divorced or widowed while compared

and 7.5% of the NUSD (Table 2).

illness were significantly

complaint

than

In that NUSD group, the nighttime that they had considerable

awakenings

difficulties

in the NUSD group

awakenings

of these subjects

were more frequent and longer at any

going back to sleep while the rate was 28.6%

of the USD group and 14.2% of the NUWSD group (p < 0.0001). 4) The absence particularly

of dreams

(as the subject

among older subjects

5) Difficulties

remembers

it) was very frequent

to start in the morning

was more frequent

in comparison

but

among older users than non users of both

groups (32.1% vs 4.4% and 15.8%; p < 0.0001). Among younger subjects, affected

among all subjects

of the three groups and younger users (close 70%).

the NUSD group was most

to NUWSD group (26.6% vs 10.1%. p < 0.0001) (Table 2).

6) Napping was more frequent only among younger users compared

to both groups of non users (57.2%

vs 33.1% and 38.5%; p < 0.05). It seems to be a common habit among older subjects

of the three groups

(about 50%) (Table 2). 7) The dissatisfaction

with SOP and the length of SOP superior to 15 minutes were characteristics

the younger USD (38.7% and 80.4%) compared 43.6% respectively).

of

to the two non user groups (3.6% and 24.9%; 13.9% and

Few older users are dissatisfied

with the duration of their sleep onset period (8.4%)

427

Psychotropic Drug Consumption and Insomnia

Table 2 Marital Status, Medical Consultation

During the Last 6-Month Period, Sleep Characteristics

Physical illness and

NUWSD

NUSD

USD

(n=?395)

(n=?42)

(n=?4)

Marital status Single < 55 y.0. 2 55 y-0. Married or living together < 55 y.0. 2 55 y.0. Separated divorced widowed < 55 y.0. r 55 y.0.

33.7 41s.P 11.2 49.4 49.6 48.9 16.9 9.5 39.9

26.9 30.6a 2.1 61.3 61.9 57.2 11.9 7.5 40.7

17.9 30.6 9.7 40.3 36.5 42.7 41.9 32.9 47.6

0.11* O.lod n.s.

Medical consultation < 55 y.0. r 55 y.0.

56.6 51.4a 72.5

61.5 59.8 72.6

83.5 73.5 90.0

O.lPJ 0.08e 0.12e

Physical illness < 55 y.0. 2 55 y.0.

13.9 8.ga 29.4

17.4 14.4b 37.7

44.4 36.7 49.4

0.17d 0.14d 0.13e

10.2 l1.2C 7.0

47.6 49.4 35.5

40.6 54.9c 31.5

0.37d 0.390 0.31d

Non refreshed at wake up < 55 y.0. 155 y.0.

27.4 33.8a 7.9

52.5 54.5 39.1

40.3 62.0b 26.4

0.19 0.17d 0.27d

Regular nighttime awakenings < 55 y.0. 2 55 y.0.

22.0 18.8a 32.0

35.5 32.9c 52.9

53.2 72.3c 40.8

0.170 0.220 0.12e

Absence of dreams < 55 y.0. 2 55 y-0.

55.0 49.oa 73.6

58.1 57.1 64.4

72.5 70.3 73.8

O.Oge O.Oge us.

Difficulties to start in the morning < 55 y-0. 2 55 y.0.

8.8 10.2b 4.4

25.2 26.6 15.8

25.1 15.7 32.1

0.2tY 0.18d 0.3od

Naps during the day < 55 y.0. 155 y.0.

36.2 33. la 45.6

39.3 38.5 44.0

52.8 57.2 50.0

0.07e 0.08e us.

Dissatisfaction < 55 y.0. > 55 y.0.

with sleep duration

Unweighted n values a Differences between b Differences between ’ Differences between ’ Differences between e Differences between

and weighted age groups age groups age groups age groups age groups

rates are significant (p < 0.0001) are significant (p < 0.005) are significant (p < 0.05) are significant (p < 0.0001) are significant (p < 0.05)

V

M. M. Ohayon and M. Caulet

428 Rate

100,

n

Dissatisfaction with sleep onset period 63 Length of sleep onset p&d > 1‘5min. 2-

< 55

2 55

y.0.

Y.“.

Fig. 2: Dissatisfaction and length of the sleep onset period (SOP) 1) USD vs NUWSD and NUSD (same age group); p < 0.0001; 2) NUSD vs USD and NUWSD (same age group); p < 0.1)001; 3) NUWSD vs USD and NUSD (same age group); p < 0.0001; 4) Differences between age groups (same group); p < 0.05.

although

over half (56%) took more than 15 minutes to fall asleep (Fig. 2). Among older subjects,

dissatisfaction Multivariate

Analvses

Two multivariate

analyses were carried out. The first one compared

group. Results of this first multivariate being a woman

(p <0.05), suffering

within the last h-month a sleep onset period

from a physical

illness (p < O.Ol), having consulted

period (p <0.05), being dissatisfied greater

user group (USD) with NUWSD

analysis have showed that being over 5.5 years of age (p
than 15 minutes

drugs. Sex and medical consultation

(p <0.05),

being dissatisfied

variables

someone

with his/her sleep duration has five times more chances

showed that only three variables

over 55 years of age has three times more chances

to be a user, while

to be a user. The second

user group (USD) with NUSD (Table 4). Results of this analysis have are significantly

associated

being over 55 years of age (p
of

since the inferior

the chance to use psychotropic

someone

analysis compared

with consumption

significant

drugs. For example, multivariate

with the sleep duration

associated

are marginally

limit of the Odds ratio is close to 1.00 (Table 3). Odd ratio represents dissatisfied

a physician

with the sleep onset period (p
(p
the

with the SOP was clearly higher in the NUSD group (p < O.fKM)l).

with consumption married

waking up during the night (p < 0.05).

(separated,

of psychotropic divorced

drugs:

or widowed)

Psychotropic

Drug Consumption

429

and Insomnia

Table 3 Results of the Logistic Regression Regarding the Effect of Consultation in the Last 6-Month Period, Physical Illness and Sleep on Consumption of Psychotropic Drugs, Users (USD) vs NUWSD

Variables

Coefficient

l3

S.E.

Odds Ratio OR

Groups of age 2 55 y.0. Sex Woman Physical illness Presence Medical consultation Presence Sleep onset period Dissatisfied Sleep onset period > 15 minutes Sleep duration Dissatisfied Dreams Never or rarely

CI 95%

1.1761b

0.328 1

3.2418

[1.70; 6.171

0.6472”

0.3040

1.9102

[ 1.05; 3.471

0.909on

0.2964

2.4818

[ 1.39; 4.441

0.74(HIc

0.3643

2.0960

[ 1.03; 4.281

1.397on

0.4328

4.0430

[1.73; 9.441

0.7374c

0.2880

2.0906

[1.19; 3.681

l.6197a

0.3154

5.0514

[2.72; 9.371

0.8343c

0.3293

2.3032

[1.21; 4.391

ap<0.0001;b p
Table 4 Results of the Logistic Regression Regarding the Effect of Consultation in the Last 6-Month Period, Physical Illness and Sleep on Consumption of Psychotropic Drugs, Users (USD) vs NUSD

Variables

Coefficient

S

S.E. OR

Groups of age 2 55 y.0. Marital status Single Formerly married Nighttime awakenings Regularly Physical illness Presence

Odds Ratio CI 95%

1.967Xa

0.3576

7.1551

[X55; 14.421

0.3816 0.949Xb

0.4411 0.4063

1.4646 2.5853

[0.62; 3.481 [1.17; 5.731

0.7976b

0.3387

2.2201

[1.14; 4.311

0.6731c

0.3607

1.9604

[0.97; 5.041

a p < 0.0001; b p < 0.05; c p = 0.06; Reference categories: < 55 y.o; Marital status- married; Nighttime awakenings, Physical illness - none. Deepness of sleep was added to this model as a confounding variable to ensure validity.

M. M. Ohayon and M. Caulet

430

Discussion There are various points of interest: 1) Itisquite

interesting to note that the population of subjects using psychotropic

from other subjects presenting

sleeping difficulties.

Multivariate

drugs can be distinguished

analyses emphasize

the age effect, being

separated, divorced or widowed, and regularly waking up during the night (at least once). The identification of age as being a determinant consumers ofpsychotropics. 2) A clear difference although awakenings

is not surprising:

it is a well known fact that older subjects are the greatest

Loneliness is a remarkable phenomenon exists between

in the population of youngerconsumers.

USD and NUSD concerning

nighttime

awakenings.

However,

are more frequent among USD subjects, they do not have the same intensity in both

cases, they are usually severe among NUSD while most USD subjects go back to sleep without difficulties. 3) It can be observed also that younger consumers of medication have many similarities with older NUSD: younger users and older NUSD are those who mostly experienced duration, napping and non restorative 4) Concerning

awakenings,

prescription

the mode of drug prescription,

general practitioners

drug (over six months).

habits for general practitioners

O’Malley, 1988; Shorr and Bauwens, 5) Concerning concerning

the amelioration

satisfaction

with sleep

sleep. are the most consulted

(72.9%). In the present sample, it was found that 75% of the consumers period a psychotropic

dissatisfaction

physicians

had taken regularly and for a long

Many authors have underlined

the need to promote new

(Eve&t et al., 1992; Hardo and Kennedy,

1991; Nolan and

1992; Shorr et al., 1990).

of the quality of sleep under psychotropic

of sleep duration, sleep onset period, refreshing

drugs, the subjects’ assessments sleep, nighttime

facility to start in the morning show that 65.7% of these consumers are paradoxically

awakenings

or

not satisfied of their sleep

and, moreover, continue to complain about their sleep. A similar conclusion was given by Pollacket al. (I 994) in a population

of elderly users. Like older subjects, psychotropic

reasons (in the elderly, resignation is experienced

as a consequence

users are resigned, but not for the same of age): if they stop their medication, they

are afraid to be enable to fall asleep. The authors think that for most people, this is one of the reasons for chronic drug consumption.

Conclusion This study shows: population

1) consumption

of the metropolitan

of psychotropic

of psychotropic

area of Montreal;

drugs in insomnia

2) 4.5% of the population

drug users); 3) the elderly and women are the most frequent

is usually long term (60.7% more than one year), and 5) surprisingly, drugs does not increase parameters

concerns

the quality of sleep when consumers

are compared

5% of the general

uses benzodiazepines

(88.2%

users; 4) this consumption

the utilization

of psychotropic

to non treated insomniacs

on

of sleep satisfaction.

Acknowledeement This research Synthelabo

was supported

France.

by the Institut

Philippe

Pine1 de Montreal

and the CNS Division

of

Psychotropic

Drug Consumption

431

and Insomnia

References

APA (American Psychiatric Association) (1987) Diagnostic and statistical manual of mental disorders, Third Edition, Revised (DSM-III-R), The American Psychiatric Association, Washington. APA (American Psychiatric Association, Washington.

Association)

(1993) DSM-IV

Draft criteria,

The American

Psychiatric

ALLGULANDER, C. and NASMAN, P. (1991) Regular hypnotic drug treatment in a sample of 32,679 Swedes: Associations with somatic and mental health, inpatient psychiatric diagnoses and suicide, derived with automated record-linkage. Psychosom. Med. a:lOl-108. DUNBAR, G. C., PERERA, M. H. and JENNER, F. A. (1989) Patterns of henzodiazepine Britain as measured by a general population survey. Br. J. Psychiatry. m:836-841. EVERITT, D. E., AVORN, J. and BAKER, M. W. (1992) Clinical decision-making treatment of insomnia. Am. .I. Med. &357-362. HARDO, P. G. and KENNEDY, KISH, L. (1965)

use in Great

in the evaluation

and

T. D. (1991) Night sedation and arthritic pain. J. R. Sot. Med. u:73-75.

Survey sampling,

John Wiley & sons Inc, New York.

LAURIER, C., DUMAS, J., GREGOIRE, J. P. and DUVAL, L. (1990) L’utilisation des tranquilisants, sedatifs et somniferes: Analyse des donnees de l’enquete Sante Quebec. Les cahiers de recherche. Direction des Communications Minis&e de la Sante et des Services sociaux, Quebec. MELLINGER, G. D., BALTER, M. D. and UHLENHUTH, Arch. Gen. Psychiatry. 42: 225-232. NOLAN L. and O’MALLEY Pharmacol. x:225-229. OHAYON,

K. 0. (1988). Patients,

M. (19--) Epidemiological

E. H. (1985)

prescribing,

study on insomnia

Insomnia

and its treatment.

and henzodiazepines.

in a General

Population,

Eur. J. Clin.

Sleep. (in press)

OHAYON, M. (1994) Use of an expert system (Eva]) in mental health epidemiological surveys. Proceedings of the Twelfth International Congress on Medical Informatics, MIE-94. 6 pages. (in press) POLLACK, C. P., PERLICK, D. and LINSNER J. P. (1994). Sleep and motor activity of community elderly who frequently use hedtime medications. Biol. Psychiatry. 35: 73-75. SHORR, R. I., BAUWENS, S. F. and LANDEFELD, C. S. (1990) Failure to limit quantities of henzodiazepine hypnotic drugs for outpatients: Placing the elderly at risk. Am. J. Med. fi:725-732. SHORR, R. I. and BAUWENS, psychiatric and nonpsychiatric STATISTICS

CANADA

S. F. (1992) Diagnosis physicians. Am. J. Med.

(1993). Profiles.

Statistics

and treatment =:78-82.

of outpatient

insomnia

by

Canada, Ottawa.

VAZQUEZ-BARQUERO, J. L., DIEZ-MANRIQUE, J. F., PENA, C., ARENAL-GONZALEZ, CUESTA. M. J. and ARTAL, J. A. (1989). Patterns of Psychotropic Drug Use in a Spanish Community. Br. J. Psychiatry. m:633-641.

A., Rural

WHO (World Health Organisation) (1992). The ICD-IO Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organisation.

Inquires and reprint requests should he addressed to: Maurice M. Ohayon, MD, PhD Centre de Recherche - Institut Philippe Pine1 de Montreal 10905, houlevard Henri-Bourassa Est Montreal (Quebec), Canada HlC 1Hl