Application of fragrance in discontinuing the long-term use of hypnotic benzodiazepines (original) (raw)
Summary
An evaluation was made of the usefulness of fragrance application in discontinuing the long-term use of hypnotic benzodiazepines in primary insomniacs with low-dose dependence. Based on the results of pentobarbital sleep time in rats, we made a new fragrance consisting primarily of sandalwood (35%), juniper berry (12%), rose (8%) and orris (6%). This mixed fragrance was found to prolong the pentobarbital sleep time in rats. A total of 42 outpatients with low-dose dependence on hypnotic benzodiazepines, all of whom met DSM-IV criteria for primary insomnia, participated in the study. In advance, all subjects attempted to reduce the doses of drugs gradually (25% reduction a week if possible) and 29 subjects who had failed to do so at all participated in the study on the application of fragrance. A mixed fragrance described above was used. A gradual tapering of hypnotic benzodiazepines (25% reduction a week if possible) was attempted while sniffing the fragrance in bed. The application of fragrance reduced the doses of hypnotic benzodiazepines in 26 of 29 subjects and 12 subjects did not require any drug for sound sleep. The present study indicated that a kind of fragrance may prove effective as an alternative to hypnotic benzodiazepines.
Introduction
Benzodiazepines as hypnotics are permitted for short-term use (National Institute of Health (NIH), 1984, Maczaj, 1993), whereas the long-term use may only have the purpose of suppression of rebound or withdrawal symptoms (Lader, 1999). Kupfer and Reynolds (1997) recommended that if hypnotic medication was used, especially in treating chronic insomnia, its use needed to be limited to 3–4 weeks, as there is no efficacy or safety data for any longer time periods. There are, however, a significant number of patients with insomnia who use medication for protracted periods (Ohayon and Caulet, 1996, Simon et al., 1996, Ancoli-Israel and Roth, 1999).
The specific concerns about the long-term treatment of chronic insomnia with benzodiazepine hypnotics include residual daytime effects such as sedation, memory impairment, falling, respiratory depression, rebound insomnia, medication abuse, tolerance development, dose escalation, dependency with withdrawal difficulties, and an increased risk of death (Kramer, 2000). Insomnia is the most frequent withdrawal symptom after developing dependence on hypnotic benzodiazepines. Poor sleep, which includes rebound insomnia (Lader, 1992) for a few days following discontinuation of the hypnotics, forces subjects to recommence the hypnotics (Ashton, 1994). A tapering schedule (Greenblatt et al., 1987) or halving the dose for a week before discontinuing (Lader and Freck, 1987) has been shown to reduce the risk of rebound insomnia, but we know from our clinical experience that it’s not the way to success. One-third of long-term benzodiazepine users have difficulty in stopping the medication (Lader, 1994). Among general practice patients, 80% who tried to stop using their benzodiazepines reported worse symptoms (Hohagen et al., 1993). Alternatives to hypnotic benzodiazepines such as cognitive therapy (Hackmann, 1993) and relaxation (Sloan et al., 1993) are applicable only under limited conditions.
Olfaction can influence various vital behaviours in mammalian species (Alberts and Galef, 1971) and we postulated that an application of sensory input may be useful in combination with such alternatives or by itself. We have already reported that fragrance is useful in the treatment of depression (Komori et al., 1995). In the present study, some fragrances were screened by pentobarbital-induced sleep time. The duration of sleep induced by intraperitoneal pentobarbital injection is an indicator of central nervous system (CNS) depressant action of a psychotropic agent administered prior to pentobarbital (Sharp et al., 1994). Using this method, several fragrances have been proven to exert a depressant effect on CNS in mice (Tsuchiya et al., 1991). Such effects of fragrances, however, are confirmed only in rodents but not yet in humans. In the present study, we made a new mixed fragrance based on the results of pentobarbital-induced sleeping time and modulated to suit most preferences of human smell. The aim of present study was to evaluate the usefulness of fragrance application in discontinuing the long-term use in primary insomniacs with low dose dependent on them.
Section snippets
Animals
Male Wistar rats, 12 weeks old, were purchased from SLC (Shizuoka, Japan) and used throughout the experiments. All rats were housed in cages in a quiet room and given access to pelleted diet and water ad libitum. Room temperature was controlled (20
±
2
°C) and lights were on between 6.00 am and 6.00 pm. The experimental protocol was approved by the Ethics Review Committee for Animal Experimentation of Mie University Graduate School of Medicine.
Exposure to fragrances
The apparatus for fragrance application, as described
Experiment 1
Table 1 shows the effects of fragrance inhalation on the sleep induced by intraperitoneal pentobarbital administration in rats. The fragrances that altered the pentobarbital sleep time by more than 5% of the control were lemon (−21%), jasmine (−8%), rose (+16%), sandalwood (+13%), juniper berry (+6%) and orris (+5%). Student’s _t_-test revealed that both the effects of lemon and rose reached a significance (p
<
0.05).
Experiment 2
The mixed fragrance prolonged the pentobarbital sleep time by 15%. ANOVA followed
Discussion
The use of fragrance to get sound sleep has been attempted since ancient times, but to our knowledge, no scientific report is available on this matter. The present study is the first medical report suggesting that a kind of fragrance, the effect of which was verified by the animal experiment, can help insomniacs to get sound sleep.
Insomnia is considered to be often influenced by subjective perception. Efficacy of hypnotics may be amplified by overestimating total sleep time in the drugged state
Cited by (4)
2011, Complementary Therapies in Clinical Practice
Having already identified that aromatherapy has positive effects on mental wellbeing it can be easily inferred that increased feelings of relaxation can help someone to sleep. Indeed, Komori et al.10 have shown that aroma inhalation supports individuals in weaning themselves off long term benzodiazepine use and they suggest that using fragrance may be a viable alternative to hypnotic medication. Given that 55% of our sample experienced better sleep, such suggestions would seem to have some merit.
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