Sleep Med 2006 May 13; (Read article online)

Hajak G

BACKGROUND AND PURPOSE: Insomnia is a chronic disorder that may require long-term treatment with hypnotic drugs. Newer drugs, such as zolpidem, zaleplon, zopiclone and eszopiclone, provide tools to maintain efficacy over a period of at least 6 months, without the marked rebound or dependence effects that are seen with traditional benzodiazepines over this period. However, even with newer drugs, the need for long-term therapy should be balanced against the symptom variability that occurs in insomnia patients over time. PATIENTS AND METHODS: Patients may not require a hypnotic drug every night, because there will be nights when no insomnia occurs and when medication is superfluous. Non-nightly (discontinuous) dosing strategies allow symptoms to be addressed as they arise. This article focuses on data obtained for a variety of non-nightly administration schedules of zolpidem. RESULTS: Results from trials treating more than 6000 patients demonstrate that discontinuous treatment with zolpidem is effective and that intermittent replacement with placebo can be carried out safely. In addition, large-scale studies show that zolpidem is effective when taken 'as needed' in daily life settings and that there is a trend for patients to spontaneously self-limit drug intake when using these flexible schedules. CONCLUSIONS: Non-nightly zolpidem, therefore, offers an approach to treatment of patients with chronic insomnia that does not result in the inappropriate daily use of drugs.