engleski

Sex differences in the use of hypnotics and benzodiazepines in patients with alcohol dependence and insomnia

Patients with alcohol dependence frequently experience sleep disturbances and insomnia. These problems manifest as difficulties in falling or staying asleep, waking up frequently at night or too early in the morning, feelings of fatigue, and lack of refreshment after the broken or unsatisfying sleep. Therefore, patients with alcohol dependence frequently use hypnotics and benzodiazepines as self-medicatation to alleviate sleep disturbances. The aim of the study was to examine sex differences in the use of hypnotics and benzodiazepines in patients with alcohol dependence with sleep disturbances. The study was conducted at the Centre for Alcoholism and Other Addictions, University Psychiatric Hospital Vrapce, Zagreb. Patients with alcohol dependence were diagnosed with Structured Clinical Interview for DSM-IV, and were subdivided into 51 male (49.5 ±10.5 years, range 26-72) and 51 female (52.0 ±10.2 years, range 29-69) participants. Drugs used were zolpidem, nitrazepam, midazolam, flurazepam, diazepam, oxazepam, alprazolam, lorazepam, or bromazepam, and patients were evaluated 5-10 days after admission. Insomnia was evaluated using items 4 (early insomnia), 5 (middle insomnia) and 6 (late insomnia) from the Hamilton Depression Rating Scale /HDRS/. All participants were additionally evaluated using Structured questionnaire for anamnesis data and Structured questionnaire for the history of hypnotic and benzodiazepine use. The results were evaluated with χ2 test, one-way ANOVA or Student’s t-test. When male alcoholic subjects were compared to female subjects, they had similar HDRS scores on early (1.41±0.57 vs. 1.51±0.51) middle (1.29±0.73 vs. 1.18±0.80) or late (0.59±0.85 vs. 0.76±0.95) insomnia, respectively. Male and female patients with alcohol dependence with insomnia differed significantly (χ2 = 18.191, df=9 ; p=0.033) in the first use of hypnotics or benzodiazepines, since female patients more frequently used oxazepam as a first medication for treating insomnia. Female alcoholic patients with insomnia used significantly higher number of medications than male patients (3.98±1.75 vs. 3.20±1.69), and this sex difference was significant (t=2.306 ; df=100 ; P=0.023). There were no sex related differences in the occurrence of the first problems with sleep (t=0.208 ; df=100 ; P=0.835), most frequently used medication for sleep disturbances (χ2 = 3.950, df=6 ; P=0.683), use of the higher dose than prescribed (χ2 = 1.231, df=1 ; P=0.267), use of medication more than one month (χ2 = 0.000, df=1 ; P=1.000), use of medication without prescription (χ2 = 0.068, df=1 ; P=0.795) or information about the side effects (χ2 = 0.055, df=1 ; P=0.815). These results show that alcoholic patients frequently experience insomnia and use hypnotics or various benzodiazepines as a self-medication or after prescription. Besides the symptoms of insomnia, benzodiazepines might also alleviate the symptoms of alcohol withdrawal. The use of hypnotics or benzodiazepines, especially oxazepam, occurred earlier in female that in male alcoholic patients with insomnia, and female patients used more frequently the combination of up to 4 drugs daily. In conclusion, these preliminary data indicate that hypnotics and benzodiazepines should be closely monitored, especially in female alcoholics with insomnia, to avoid self medication and addiction.

hypnotics; benzodiazepines; alcohol dependence; insomnia; sex differences

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