In order to assess potential tolerance to benzodiazepine hypnotics, triazolam 0.25mg was given nightly to 15 insomniacs. Total sleep time was significantly increased, and sleep latency decreased, during all 4 weeks of active drug compared with a 1-week placebo baseline period. Sleep efficiency was significantly improved on drug weeks 1, 2 and 4. In contrast, subjective effects on sleep were more complex. Reported total sleep increased, and reported number of awakenings decreased, during the entire 4 weeks. Reported sleep latency, on the other hand, was significantly decreased only on the first 2 weeks of drug administration. These results suggest that the differences in the findings of various studies regarding tolerance may be related to the type of insomniac and the outcome measures used. One speculation for future work might be that patients who tend to focus on the ability to fall asleep quickly will report tolerance with chronic use, while those who are more concerned with total amount of sleep and awakenings during the night will report continued effectiveness.
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