PT657. Take your sleeping pills 7 hours before your wake-up time

Complex sleep behaviors (CSBs) are often associated with hypnotics use. This study aimed to investigate the prevalence and correlates of CSBs among individuals who were taking flunitrazepam from psychiatric outpatient clinics. A total of 268 participants who were administered flunitrazepam for at least 3 months were enrolled from psychiatric outpatient clinics from June 2011 to May 2012. The occurrence of CSBs, demographic characteristics, the dose and duration of flunitrazepam use, psychiatric diagnoses, physical illnesses, and alcohol drinking were collected. Logistic regression analysis was used to examine the clinical correlates of CSBs. In total, there were 66 (24.6%) participants reporting CSBs. Logistic regression analysis showed a high dose (>2 mg) of flunitrazepam (Odd Ratio [OR] = 1.978, 95% Confidence Interval [CI]: 1.066–3.671, p = .031) and alcohol use (OR = 2.034, 95% CI: 1.046–3.955, p = .036) were significantly associated the occurrence of CSBs. Sex, age, duration of flunitrazepam use, psychiatric diagnoses and physical illnesses were not significantly associated the occurrence of CSBs. CSBs should be monitored routinely in flunitrazepam users, especially among those with a high dose of flunitrazepam and alcohol drinking. PT657 Take your sleeping pills 7 hours before your wake-up time Soyoung Youn, M.D., Chi-Won C. Han, B.A., Boram Park, M.D., Suyeon Lee, M.D., Kikyoung Yi, M.D., Seockhoon Chung, M.D., Ph.D. Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea *Corresponding author: Seockhoon Chung, M.D., Ph.D. Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 86, Olympic-ro, 43-gil, Songpa-gu, Seoul, 138–736, Korea Tel: +(82)-2-3010-3411 Fax: +(82)-2-485-8381 E-mail: [email protected] Abstract Study objectives: The aim of this study is to investigate the effectiveness and practicality of the newly proposed guidance to take hypnotics 7 hours before one’s usual wake-up time, compared to the conventional guidance to do so 30 minutes before bedtime. Methods: Subjects with primary insomnia who were not satisfied with their hypnotics were included in this study. The type of sleeping pill, usual hypnotics administration time, bedtime, sleep onset time, and wake-up time were surveyed. Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Dysfunctional Belief and Attitudes about Sleep (DBAS), and Pre-Sleep Arousal Scale (PSAS) were assessed at baseline. For 2 weeks, patients were instructed to take their own sleeping pills 7 hours before their usual wake-up times. The above questions and sleep scales were assessed again after the end of this period. Results: Among 32 subjects, 23 patients were successfully followed up. Adhering to the said 7-hour instruction, 73.9% (n=17) were satisfied with their sleeping pills. Mean hypnotics administration time was significantly delayed from 9:32 pm ± 0:58 to 10:55 pm ± 0:46 (p<0.001) and duration from pills to wakeup time (PTW) was shortened from 9.0 ± 1.1 to 7.1 ± 0.8 hours (p<0.001). Sleep latency (p=0.023) was significantly shorted, and ISI and PSQI scores significantly improved (p<0.001). The improvements of ISI and PSQI were positively correlated with the shortened sleep latency (r=0.49, p<0.05) and PTW (r=0.54, p<0.05), respectively. Conclusions: Advising patients to take hypnotics about 7 hours before their usual wake-up time could increase the level of satisfaction with their original medication as is. In incorporating concepts of cognitive behavioral therapy, this recommendation may serve as a simple but considerably useful guidance on the proper timing for taking prescribed sleeping pills.