Eszopiclone is used as a hypnotic agent in the management of transient and chronic insomnia. In controlled clinical studies, eszopiclone reportedly has been shown to have continued efficacy in decreasing sleep latency, improving sleep maintenance, and prolonging total sleep time when administered nightly for periods up to 6 months in duration.
Efficacy of eszopiclone for the management of transient insomnia was established in a controlled study in adults experiencing such insomnia during the first night in a sleep laboratory. In this study, 2- and 3-mg doses of eszopiclone were superior to placebo on the polysomnographic parameters of latency to persistent sleep (LPS) and wake time after sleep onset (WASO). Individuals receiving the 3-mg dose, but not those receiving the 2-mg dose, experienced substantially fewer awakenings than did individuals receiving placebo. Residual daytime psychomotor and/or cognitive impairment, as rated on a visual analog scale for morning sleepiness and assessed objectively using the Digit Symbol Substitution test (DSST), appeared to be minimal at eszopiclone doses of 3 mg or less. At such doses, sleep architecture (i.e., the percentage of time spent in each sleep stage) generally was preserved.
Efficacy of eszopiclone for the management of chronic insomnia was established in 5 controlled studies of up to 6 months' duration, including 3 studies in adults and 2 in geriatric patients. Results of these studies indicate that usual doses of eszopiclone (i.e., 2-3 mg in adults and 1-2 mg in geriatric patients) substantially decrease sleep latency; however, only the 3-mg dose in adults and the 2-mg dose in geriatric patients were superior to placebo on measures of sleep maintenance (e.g., WASO). Pharmacodynamic tolerance and adaptation to the hypnotic effect of eszopiclone were not observed during 6 months of therapy with the drug. Evidence to suggest, however, that such sleep improvements are maintained following discontinuance of eszopiclone is currently lacking. Consequently, some clinicians suggest that use of hypnotic agents in the management of chronic insomnia should be reserved for patients who do not respond to psychotherapy/behavioral therapies (e.g., relaxation techniques, sleep hygiene education, sleep curtailment, stimulus control therapy).
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