Self Help Program for Hypnotics Withdrawal in Insomniac Patients (PROPERSOM)
Self-help Program for Hypnotics Withdrawal in Chronic Insomniac Patients: A Randomized Controlled Clinical Trial
Persistent insomnia has a high prevalence in French general population affecting between 15.8 % and 19 % of adults. In France, the disease is mainly managed by general practitioners (GP) who usually proposed intermediate half-life benzodiazepines and Z-drugs in first-line treatment. French Health authorities recommend restricting the consumption of both hypnotics to no more than 4 weeks, considering their potential adverse effects (memory impairment, altered sleep physiology, motor-vehicle crash), and the risk of tolerance and dependence. However, it appears that a majority of patients become chronic users. Therefore, discontinuation of benzodiazepines/Z-drugs is recommended, but it may appear as a challenge due to withdrawal symptoms and psychological factors (anticipatory anxiety, fear of rebound insomnia).
Numerous studies have shown that programs based on Cognitive-Behavioural Therapy (CBT) principles improve sleep and daily life quality leading to hypnotic taper and maintain of hypnotic abstinence in insomniac patients. Cognitive-Behavioural Therapy (CBT) is based on 4 components: sleep restriction, stimulus control, cognitive therapy and sleep hygiene education. This therapy is dependent on a therapeutic alliance between practitioner and patient. Unfortunately, there are an insufficient number of trained CBT experts especially in France.
The implementation of an internet-delivered self-help program based on time-in-bed restriction and stimulus control may be an issue within the context of general practice.
Online programs based on CBT principles have been proved to be effective in improving the sleep and daytime functioning in this population, but the studies were realized in small patients groups.
Investigators hypothesis is that a simple and internet-delivered short-term program based on sleep restriction therapy and stimulus control (following to a GP consultation) may facilitate hypnotics discontinuation (benzodiazepines/Z-drugs) in patient with insomnia disorder still reporting sleep complaints in comparison with a tapering alone (no access to the self-help program).
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Tipo de estudo
Inscrição (Real)
Estágio
- Não aplicável
Contactos e Locais
Locais de estudo
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Bordeaux, França, 33076
- CHU de Bordeaux
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Garches, França, 92380
- APHP Hôpital Raymond Poincaré
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Lille, França, 59037
- CHRU de Lille
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Montpellier, França, 34295
- CHU de Montpellier
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Paris, França, 75013
- AP-HP Hopital Pitie-Salpetriere
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Paris, França, 75181
- APHP Hôtel-Dieu de Paris
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
Inclusion Criteria:
- Patient complaining of persistent insomnia without co-morbidities (DSM-5) and treated for at least 3 months with monotherapy of:
- Zopiclone or Zolpidem with usual doses (3.5 doses per week at least to a maximum of 14 per week) OR Intermediate half-life benzodiazepines included in the appendix 1 list with usual doses (3.5 doses per week at least to a maximum of 14 per week)
- Motivated to stop hypnotic treatment (score >5 on a 1 to 10 degrees VAS)
- 18 to 75 years old,
- Man or woman,
- Having an internet connection,
- Affiliated to a national health service,
- Having given written informed consent to participate in the trial.
Exclusion Criteria:
- Patient with 2 psychotropic drugs or more taken daily for insomnia complaints (antidepressant, anxiolytic and antihistamine treatments will be allowed if they are prescribed for a stabilized mood and/or anxiety disorder).
- Patient not believing in short-term simple self-help program
- Insomnia with comorbidities other than a stabilized mood and/or anxiety disorder
- Night and shift-workers,
- Current Psychiatric disorder : mood disorder (depression, bipolar disorder) with a BDI score > 19, anxiety disorder, psychosis
- All sleep disorders other than persistent insomnia (clinical interview),
- Progressive neurological diseases that include restless legs syndrome,
- Unstable Cardiovascular disease,
- Unstable respiratory or endocrinological diseases (clinical interview),
- Drug addiction, alcohol addiction during the previous 6 months (clinical interview),
- Having undertaken trans-meridian travel (± 3H) in the previous 1 month
- Pregnant or lactating woman,
- Current participation in psychotherapy.
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Cuidados de suporte
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
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Experimental: Standardized hypnotic taper and self-help program
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The gradual hypnotic taper is standardized and is adjusted depending on the hypnotic treatment and the initial weekly dose.
The practitioner will give to the patient a calendar for the taper period with the specific dose for each day (name of hypnotic, quantity and dose of pills).
The short-term simple self-help program consists in:
The restriction of time in bed would be delivered by an e-health tool (web site). The patient will have to connect to the web site with an individual connexion password. He will connect every day to complete an on-line sleep diary during the period of the simple short-term behavioural program (5 weeks). After this period, patients will have the choice to continue connecting to the website and using the program or to stop using the program. |
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Comparador Ativo: Standardized hypnotic taper only
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The gradual hypnotic taper is standardized and is adjusted depending on the hypnotic treatment and the initial weekly dose.
The practitioner will give to the patient a calendar for the taper period with the specific dose for each day (name of hypnotic, quantity and dose of pills).
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Urinary hypnotics screening assessed during Visit 2
Prazo: 7 weeks after randomization visit
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Urine will be frozen and afterwards analysed by a central laboratory (Unité de biologie médicale multidisciplinaire, CHU Bordeaux) for hypnotics (benzodiazepines and Z-drugs) using Gas Chromatography-Mass Spectrometry.
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7 weeks after randomization visit
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Urinary hypnotics screening assessed during Visit 3
Prazo: 17 weeks after randomization visit
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Urine will be frozen and afterwards analysed by a central laboratory (Unité de biologie médicale multidisciplinaire, CHU Bordeaux) for hypnotics (benzodiazepines and Z-drugs) using Gas Chromatography-Mass Spectrometry.
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17 weeks after randomization visit
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Total sleep time obtained by actimetry
Prazo: During 10 nights before Visit 2 wich is scheduled 7 weeks after randomization visit
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During 10 nights before Visit 2 wich is scheduled 7 weeks after randomization visit
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Sleep efficiency obtained by actimetry
Prazo: During 10 nights before Visit 2 wich is scheduled 7 weeks after randomization visit
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During 10 nights before Visit 2 wich is scheduled 7 weeks after randomization visit
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Wake after sleep onset obtained by actimetry
Prazo: During 10 nights before Visit 2 wich is scheduled 7 weeks after randomization visit
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During 10 nights before Visit 2 wich is scheduled 7 weeks after randomization visit
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Sleep latency obtained by actimetry
Prazo: During 10 nights before Visit 2 wich is scheduled 7 weeks after randomization visit
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During 10 nights before Visit 2 wich is scheduled 7 weeks after randomization visit
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Total sleep time obtained by sleep diary
Prazo: Every night between Pre-Inclusion visit (Visit 0) and Week 5 after Visit 1
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Every night between Pre-Inclusion visit (Visit 0) and Week 5 after Visit 1
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Sleep efficiency obtained by sleep diary
Prazo: Every night between Pre-Inclusion visit (Visit 0) and Week 5 after Visit 1
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Every night between Pre-Inclusion visit (Visit 0) and Week 5 after Visit 1
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Wake after sleep onset obtained by sleep diary
Prazo: Every night between Pre-Inclusion visit (Visit 0) and Week 5 after Visit 1
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Every night between Pre-Inclusion visit (Visit 0) and Week 5 after Visit 1
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Sleep latency obtained by sleep diary
Prazo: Every night between Pre-Inclusion visit (Visit 0) and Week 5 after Visit 1
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Every night between Pre-Inclusion visit (Visit 0) and Week 5 after Visit 1
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Insomnia Severity Scale (ISI) score
Prazo: Pre-inclusion visit (between 21 to 10 days before randomization), randomization visit (Visit 1) ,7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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Pre-inclusion visit (between 21 to 10 days before randomization), randomization visit (Visit 1) ,7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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Leeds Sleep Evaluation Questionnaire (LSEQ) score
Prazo: 7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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Beck Depression Inventory Second Edition (BDI-II) score
Prazo: Pre-inclusion visit (between 21 to 10 days before randomization), randomization visit (Visit 1) ,7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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Pre-inclusion visit (between 21 to 10 days before randomization), randomization visit (Visit 1) ,7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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Beck anxiety Inventory (BAI) score
Prazo: Pre-inclusion visit (between 21 to 10 days before randomization), randomization visit (Visit 1) ,7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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Pre-inclusion visit (between 21 to 10 days before randomization), randomization visit (Visit 1) ,7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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Short-Form SF-36 Health Survey score
Prazo: Pre-inclusion visit (between 21 to 10 days before randomization), randomization visit (Visit 1) ,7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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Pre-inclusion visit (between 21 to 10 days before randomization), randomization visit (Visit 1) ,7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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Benzodiazepine Withdrawal Symptoms Questionnaire (BWSQ) score
Prazo: 7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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Self-efficiency visual analog scale score
Prazo: Pre-inclusion visit (between 21 to 10 days before randomization), randomization visit (Visit 1) and 7 weeks after randomization (Visit 2)
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Pre-inclusion visit (between 21 to 10 days before randomization), randomization visit (Visit 1) and 7 weeks after randomization (Visit 2)
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Reasons for non-compliance obtained during patient interview
Prazo: 7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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7 weeks after randomization (Visit 2) and 17 weeks after randomization (Visit 3)
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Cadeira de estudo: Antoine BENARD, MD-PhD, USMR - CHU de Bordeaux
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Conclusão Primária (Real)
Conclusão do estudo (Real)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Estimativa)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- CHUBX 2014/35
Plano para dados de participantes individuais (IPD)
Planeja compartilhar dados de participantes individuais (IPD)?
Descrição do plano IPD
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