Sleep-onset latency

Sleep onset latency generally is improved (i.e., shortened) with all BZD hypnotics, although this may vary considerably with individual patients. Those with relatively rapid onset of hypnotic activity include flurazepam, diazepam, and chlorazepate. Somewhat slower onset occurs with triazolam, estazolam, quazepam. 

Noting that chronic insomniacs often underestimate their actual sleep time, Spielman et al. (183) conducted a study in which subjects initially were allowed to stay in bed only as long as their own estimate of time spent asleep. Results indicated that the mild sleep deprivation produced tended to improve sleep onset latency and efficiency. 

The effect of sleep deprivation on different age groups has also been tested using the MSLT. Sleep loss in young adolescents was assessed by examining the effects of one night s sleep loss in 12 subjects whose ages ranged from 11.7 to 14.6 years. MSLTs showed a marked reduction of sleep-onset latency from 0530... 

In an earlier experiment, cumulative increases in PVT lapses across 7 days of sleep restricted to approximately 5 hr per night (29) were shown to be strongly related (r = -0.95) to sleep onset latency as assessed by the Multiple Sleep Latency Test (MSLT) in a nearly identical protocol (72). It appears that PVT performance lapse frequency and the well-validated physiological measure of sleep propensity may reflect the same basic process of escalating sleep pressure with sleep loss. 

Two meta-analyses on the efficacy of nonpharmacological interventions for insomnia have shown that SRT produces, along with stimulus control therapy, among the largest effect sizes on sleep onset latency and wake after sleep onset variables (3,4). However, SRT alone has been evaluated in significantly fewer studies than other interventions. Furthermore, results from meta-analyses have also shown that SRT produces a reduction of TST, particularly at posttreatment, with a rebound/gain at short-term follow-ups. Three treatment studies of late-life insomnia have directly compared the relative efficacy of SRT to other nonphar-... 

On the other hand, hypnotics, although they improve total sleep time as well as sleep onset latency during short-term use, induce rebound insomnia after cessation of treatment [56, 57], This is pertinent not only for the short half-life benzodiazepines, but also for newer hypnotic drugs such as zolpidem [58], whereas when they were first launched, there were reports of a more favorable profile for rebound insomnia and daytime anxiety [59], Moreover, a recent review of controlled trials that compared benzodiazepines to the Z-drugs (zaleplon, zolpidem and zopiclone), for short-term management of insomnia, concludes that short-term-acting drugs are equally effective [60],... 

The studies on subjective sleep complaints in patients with panic disorder have not obtained consistent results. One study showed that 68% of patients with panic disorder reported moderately to severely impaired sleep, compared to only 15% of healthy controls, and 26% of panic disorder patients complained of frequent awakenings, compared to none in healthy controls [14], Another study, however, did not find significantly higher rate of sleep complaints in patients with panic disorder than in normal controls [15]. The findings on PSG sleep in patients with panic disorder are also not consistent across studies. Different PSG sleep features found included increased sleep onset latency, decreased total sleep time [16,17], decreased sleep efficiency [16-18], decreased stage 4 sleep [18], and increased movement time [19, 20], One study reported no remarkable findings [21],... 

SOL, sleep onset latency SE, sleep efficiency TST, total sleep time REML, REM sleep latency SWS%, percentage of slow wave sleep MT, movement time SA, sleep apnea events —, no significant differences ftor li, consistently found increased or decreased l or t, some evidence of increase or decrease , inconsistent results. 

SWS = Slow Wave Sleep (Stage 3-4), SOL = Sleep Onset Latency, BZD = Benzodiazepine, NSAD = Non Steroidal Anti-inflammatory Drug, ETOH = Alcohol... 

Evaluation of the effect of hypnotic drugs on sleep induction and maintenance in patients with chronic primary insomnia is based on sleep laboratory studies and subjective data from clinical trials. The sleep induced by benzodiazepine hypnotics, including midazolam, triazolam, temazepam, flunitrazepam, quazepam, and flu-razepam, is characterized by shortened sleep-onset latency, decreased number of... 

Zolpidem 10 mg/day and zopiclone 7.5 mg/day, given at night, have been compared in a 14-day, double-blind study in 479 chronic primary insomniacs (17). With zolpidem 68% of the patients were rated at least moderately improved, versus 62% with zopiclone. However, with zolpidem sleep-onset latency improved in significantly more patients (86 versus 78%). In addition, significantly fewer patients who took zolpidem had drug-related adverse events (31 versus 45%) bitter taste accounted for 5.8% of such complaints with zolpidem compared with 40% with zopiclone. In conclusion, zolpidem was at least as effective as zopiclone but showed significantly less rebound on withdrawal overall it was better tolerated. 

The three hypnotics were equally effective as sleep medication for sleep onset latency, duration of sleep, and condition on awakening, whereas zopiclone provided significantly fewer spontaneous awakenings. 

Midazolam (7.5 mg), flunitrazepam (Img), and placebo were compared in a double-blind crossover trial to study the effects of drugs on sleep, nighttime respiration, and body movements in five elderly insomniac patients. No signs of increased respiratory resistance was seen with either of the drugs or placebo. There were no differences in the quality and quantity of sleep induced by either drug. Only the sleep onset latency was shorter with flunitraz-epam compared with midazolam and placebo (80). 

Authority EFS (2010) Scientific opinion on the substantiation of health claims related to melatonin and subjective feelings of jet lag (ID1953), and reduction of sleep onset latency, and improvement of sleep quality (ID 1953) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA J 8 1467... 

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