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April 11, 1977

Chronic Insomnia Provokes More Prescriptions Than Diagnoses

JAMA. 1977;237(15):1569. doi:10.1001/jama.1977.03270420037012

CHRONIC insomnia, like most symptoms, arises from many causes but, unlike most symptoms, attracts little diagnostic interest. Often, on complaining of sleeplessness, a patient promptly receives a prescription for hypnotics. Once regular use of hypnotics begins, giving them up becomes arduous. Regular use of hypnotics might be more reasonable were they more than temporarily effective. Unfortunately, however, chronic hypnotic use does not get the patient to sleep any faster,1 but rather increases nightly awakenings, abolishes deep sleep,2 and continues to affect sleep patterns for five weeks after drug withdrawal.3 The ready drug prescriptions available, it seems, have not only led to a scourge of drug habituation, but may well have lessened the quality of sleep obtained by insomniac patients. Additionally, it has bolstered the unrealistic notion that one ought first to resort to drugs to alleviate chronic insomnia. The patient relying on hypnotics is often left with