Chronic use of hypnotics in a family practice--patients' reluctance to stop treatment.

Insomnia is a common symptom in family practice, and hypnotics are frequently prescribed for its treatment. A survey was performed in an urban clinic serving 1900 persons in order to detect the prevalence of this disorder and to reassess the need for hypnotics. Sixty-one patients were identified who were taking prescribed hypnotic drugs, mainly benzodiazepines. All were over the age of 40, and they comprised 8.1% of this age group. Forty-five were chronic users, taking hypnotics for more than 4 months during a 6-month study period. Eighty-nine percent of these chronic users were above 60 years of age. Seventy-seven percent had difficulty initiating sleep and 23% had problems maintaining sleep. Information was given to these patients on the side effects and possible addictive nature of chronic hypnotic use. Different kinds of psychological support were offered as alternatives to drug treatment, but these were refused by all. We conclude that in view of the addiction associated with chronic use and the difficulty of weaning patients off the sleeping pill, there is a place for more careful evaluation and management before hypnotics are prescribed.