Drugs and insomnia.

261 38 Buchsbaum MS, Davis GC, Bunney WE Jr. Naloxone alters pain perception and somatosensory evoked potentials in normal subjects. inhibitor of morphine-and beta-endorphin-induced analgesia. Insomnia occurs in so many circumstances that it is often difficult to know when a hypnotic should be used and which is most suitable. In the past 10 years or so considerable advances have been made, however, in understanding sleep and sleep disturbance, and many more drugs, both diazepines and non-diazepines, have been developed to promote sleep. Late last year the National Institutes of Health, Bethesda, held a consensus development conference on "Drugs and insomnia: the use of medications to promote sleep." A much clearer view of the use of hypnotics evolved, and the National Institutes of Health is to be congratulated for providing the opportunity to make this possible. Consensus conferences are little known outside the United States, but they provide a useful way of updating knowledge. On this occasion after a day and a half of invited presentations a panel of psychiatrists, pharmacologists, epidemiologists, general practitioners, and representatives of the public prepared a statement which dealt with the circumstances in which hypnotics should be used, the pharmacological properties which should be considered, and the principal cautions and risks associated with prescribing these drugs. Insomnia is a symptom of various conditions and indicates the need for systematic assessment of the medical, psychiatric, and other causes. Analysis of insomnia is best done under three headings-transient, short term, and long term (chronic). Transient insomnia occurs in those who normally sleep well and is usually due to an alteration in the conditions which surround sleep (for example, noise) or to an unusual pattern of rest, as in shiftwork or intercontinental travel. A hypnotic may or may not be needed, depending on whether the patient reacts unfavourably to unfamiliar surroundings, but when treatment is given a rapidly eliminated hypnotic is appropriate, and it should be needed on only a couple of occasions. Short term insomnia is usually related to an emotional problem or to a serious medical illness. It may last for a few weeks and may recur. Good management is needed to avoid long term problems, and proper attention to sleep hygiene is essential. A hypnotic is likely to be useful, but it should be given for not more than three weeks-preferably for only a week or so. Intermittent use is desirable, with skipping of some nightly …