Home' Australian Pharmacist : Australian Pharmacist November 2012 Contents 880 Australian Pharmacist November 2012 I ©Pharmaceutical Society of Australia Ltd.
Continuing Professional Development
COUNSELLING IN PRACTICE
• Australasian Sleep Association www.
• Sleep disorders Australia www.sleepoz.
• Sleep Services Australia www.
A sleep diary can be downloaded from
the NPS website at: www.nps.org.ausleep.
Education, information and
counselling treatments for patients
who are experiencing benzodiazepine
dependency can be found at:
• Reconnexion www.reconnexion.org.au
• beyondblue www.beyondblue.org.au
Back to Michael
It is likely that Michael is dependent on
his oxazepam as he has been taking it for
six months, feels that the medication is
not having the same effect as it used to
and he has increased his dose to try to
get to sleep. His girlfriend claims that he
is irritable all the time, which indicates his
benzodiazepine use is interfering with his
social life and relationships.
The pharmacist should discuss with
Michael his willingness to discontinue
or reduce the dose of his oxazepam.
He should also be referred to his GP
for an assessment of his insomnia and
to agree on a dose reduction schedule
to minimise the risk of withdrawal
symptoms. The pharmacist should
explain why sleep difficulties are best
managed without drugs, reassure him
that there is considerable variation
in the amount of sleep needed by an
individual and that less than eight hours
every night is acceptable. Michael should
also be counselled about appropriate
sleep hygiene measures and other
behavioural techniques that have been
successfully used for treating insomnia.
The pharmacist can explain the benefits
of non-drug therapies such as better
sleep quality, improved alertness and
quality of life and the potential reduction
in accidents and injuries.
1. Woolcock K. Essential CPD: Sleep Disorders. Canberra:
Pharmaceutical Society of Australia; 2005.
2. Schutte-Rodin S, Broch L, Buysse D, et al. Clinical Guideline
for the Evaluation and Management of Chronic Insomnia in
Adults. J Clin Sleep Med. 2008;4:487--504.
3. NPS. Prescribing Practice Review 49: Management options for
improving sleep. Surrey Hills, NSW: NPS; 2010.
4. Pharmaceutical Society of Australia. Self Care Fact Card:
Sleeping Problems. Canberra: Pharmaceutical Society of
5. Rossi S, ed. Australian Medicines Handbook. Adelaide:
Australian Medicines Handbook; 2012.
6. Knott L. Benzodiazepine Dependence [online]. 2011 [Accessed
02 Sept 2012]. At: www.patient.co.uk/doctor/Benzodiazepine-
7. Psychotropic Expert Group. Therapeutic Guidelines:
Psychotropic, Version 6. Melbourne: Therapeutic Guidelines;
8. Saunders JB, Yang J. Clinical protocols for detoxification
in hospitals and detoxification facilities [online]. 2002.
[Accessed 02 Sept 2012] At: www.health.qld.gov.au/atod/
9. Stopping benzodiazepines and Z drugs [online]. 2012.
[Accessed 02 Sep 2012] At: www.patient.co.uk
10. Beyondblue. Fact Sheet 44: Benzodiazepines (tranquillisers
and sleeping pills) [online]. [Accessed 02 Sept 2012]. At: www.
11. NPS. NPS News 67: Addressing hypnotic medicines use in
primary care. Surrey Hills, NSW: NPS; 2010.
12. NHS Clinical Knowledge Summaries. Clinical Topics: Insomnia
-- Management [online]. [Accessed 02 Sep 2012]. At: www.
13. Australian Government Department of Veteran's Affairs.
Veterans' MATES Therapeutic Brief 18. Insomnia Management:
Effective approaches for a common problem [online]. 2009.
[Accessed 02 Sep 2012]. At: www.veteransmates.net.au/
14. Ramakrishnan K, Scheid DC. Treatment options for insomnia.
Am Fam Physician. 2007;76:517--26.
15. NPS. A reduction plan for your sleeping tablets [online]. 2010.
[Accessed on 02 Sep 2012]. At: www.nps.org.au/__data/assets/
16. Kenny P, Swan A, Berends L, et al. Alcohol and other drug
withdrawal: practice guidelines [online]. 2009. [Accessed 02
Sept 2012] At: www.turningpoint.org.au
17. NSW Department of Health. NSW drug and alcohol withdrawal
clinical practice guidelines [online]. 2008. [Accessed 02 Sep
2012] At: www.health.nsw.gov.au/policies/gl/2008/pdf/
1. Which ONE of the following
statements about benzodiazepines
a) They should be prescribed on a long-
term basis for insomnia.
b) They have anti-anxiety properties.
c) Prolonged treatment decreases
the likelihood of tolerance and
d) After long-term treatment, high doses
can be stopped abruptly.
e) Short-term treatment is associated
2. Which ONE of the following
is a common symptom of
c) Dry mouth.
d) Increased appetite.
3. Which ONE of the following
statements is CORRECT? Stopping
long-term benzodiazepine therapy
a) increase the risk of falls.
b) decrease quality of life.
c) decrease alertness.
d) improve memory impairment.
e) increase risk of motor vehicle
4. Which ONE of the following
statements is CORRECT?
a) Diazepam is a short-acting
b) Oxazepam is a long-acting
c) Nitrazepam is a very short-acting
d) Midazolam is a medium-acting
e) Temazepam is a short-acting
5. Which ONE of the following
statements regarding good sleep
hygiene is CORRECT?
a) Wake up at irregular times.
b) Sleep in a bright, light room with the
c) Reserve bedroom for sleep and
d) Participate in exercise immediately
before going to bed.
e) It's great to have the dog sleep on
Take home message
• Non-drug therapies like cognitive
behavioural therapy and sleep
hygiene practices are recommended
as first-line treatments for insomnia
• Benzodiazepines can be prescribed
for insomnia and may be useful
when used intermittently or for
short periods of time (e.g. less than
• To minimise withdrawal effects, the
dose of benzodiazepines should be
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