Many epidemiologic studies have found insomnia to be associated with hypnotic drug use. It is often supposed that insomnia causes people to take hypnotics. The reciprocal that hypnotics might cause insomnia has rarely been considered. Randomized placebo-controlled clinical trials have now demonstrated that hypnotics do indeed cause insomnia.Mayer et al. reported a 6-month clinical trial of ramelteon 8 mg versus parallel placebo [1]. During subsequent placebo run-out, the placebo group had PSG-recorded TST of 383.0 min +- SE 4.0, whereas the ramelteon group slept 372.9 min +- SE 4.1. The difference in means was significant (P<0.05, one-tailed, my computation). By focusing on rebound insomnia compared to baseline (rather than to placebo) and by focusing on sleep latency, the authors claimed that "no withdrawal symptoms or rebound insomnia were detected after ramelteon discontinuation."
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