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Brochure insomnie - version anglaise

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Risks related to benzodiazepine use and benefits of withdrawal in the elderly Benzodiazepine treatment exposes the elderly to: - falls (grade B) and their consequences - cognitive impairment (grade C) - traffic accidents, especially in drivers (grade C). Gradual withdrawal does not impact negatively on quality of life (grade C) and may improve some cognitive functions (grade C) (Source: “How to discontinue benzodiazepines and closely related drugs in the PROGRAM FOR 2007 - 2010 elderly” – HAS guidelines 2007) “Improving the prescription of psychotropic drugs PROGRAM 2007 - 2010 in the elderly in France” STATISTICS « Improving the prescription of psychotropic drugs in the French elderly” In France, 32% of over the over-65s and 40% of the over-85s were Sleep complaints prescribed hypnotics or anxiolytics between September and December INSOM NIA 2007 (Source: Report of the French National Health Insurance funds (CNAMTS, RSI, MSA), Appraisal step 2008 2008 Milestone French National Institute of Public Health Surveillance (InVS), HAS, and the working group ”Improving the prescription of psychotropic drugs in the elderly, in press). These statistics confirm earlier estimations, e.g. those of the 2006 report of the Parliamentary Office for health policy assessment (OPEPS) on BACKGROUND prescriptions dating back three years or more (Source: OPEPS 2006 report: “Proper use of psychotropic drugs”).

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PROGRAM FOR2007 - 2010 “Improving the prescription of psychotropic drugs in the elderly in France”  Sleep complaints  2008 Milestone
 
 
   BACKGROUND  Sleep-related complaints are common but not all are related to insomnia, particularly in the elderly. They may be due to pain, anxiety, urinary problems, etc. Physiological modifications affecting sleep also occur with ageing. In the general population, the prevalence of established sleep disorders is about 10 to 20%. Currently there are no data on the prevalence of sleep disorders in the elderly in France.  Ageing is accompanied by changes in sleep patterns. The elderly sleep less at night and nap during the day.  Complaints about sleep, including those due to established insomnia, do not warrant the long-term prescription of sleeping pills (hypnotic drugs, mainly benzodiazepines and the related “Z drugs”). Sleeping pills are effective only in the very short term and cause adverse effects particularly in the elderly.  Sleeping pills are only indicated in a very limited number of sleep disorders.
Risks related to benzodiazepine use and benefits of withdrawal in the elderly Benzodiazepine treatment exposes the elderly to: - falls (grade B) and their consequences - cognitive impairment (grade C)  traffic accidents, especially in drivers (grade C). -Gradual withdrawal does not impact negatively on quality of life (grade C) and may improve some cognitive functions (grade C) (Source: “How to discontinue benzodiazepines and closely related drugs in the elderly” – HAS guidelines 2007)  STATISTICS In France, 32% of over the over-65s and 40% of the over-85s were prescribed hypnotics or anxiolytics between September and December 2007 (of the French National Health Insurance funds (CNAMTS, RSI, MSA),Source: Report French National Institute of Public Health Surveillance (InVS), HAS, and the working group ”Improving the prescription of psychotropic drugs in the elderly, in press.) These statistics confirm earlier estimations, e.g. those of the 2006 report of the Parliamentary Office for health policy assessment (OPEPS) on prescriptions dating back three years or more (Source: OPEPS 2006 report: “Proper use of psychotropic drugs”).  In conclusion  - and anxiolytic use is without doubt excessive in France, Hypnotic particularly among the elderly. - dates back several decades. Overuse   IMPROVING PRACTICE The priority for improving practice is to assist practitioners and patients. 1.To propose ways of helping patients discontinue sleeping pills, even in patients dependant on their drugs 2.To improve the diagnosis of sleep disorders in order to detect genuine insomnia requiring specific management 3.To reduce the rescri ills in rate of slee tion