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- Sep 21, 2015
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Specialists routinely turned to opioids for chronic pain and that's turned out super awesome.
Having read through a lot of the most recent guidelines, many the meta analysis argue that the NNT < NNH across benzos and benzo-agonists. Looking at their (sleep med society) recs and evidence for specific drugs, the benefits are generally "minimal" and the harms considered are only those from short term RTCs, not the known long term consequences of gaba agonists. All of the evidence is weak at best and only for short term use but doesn't account for whether "short term use" means that people in real life actually stop taking them. Finally, the primary end points are all sleep time/quality, but there is no evidence of benefit on the secondary effects of insomnia which is what we actually care about! In fact, for some of the drugs you're more likely to have daytime somnolence than on placebo (hi Belsomra). So you can't sleep? Let's make you extra tired!
Remember, even clinical specialists have an inherent conflict of interest. If you're a sleep specialist and don't have anything to prescribe for many of your patients, do you stay in business? Can you make the same living doing CBTi only?
Having read through a lot of the most recent guidelines, many the meta analysis argue that the NNT < NNH across benzos and benzo-agonists. Looking at their (sleep med society) recs and evidence for specific drugs, the benefits are generally "minimal" and the harms considered are only those from short term RTCs, not the known long term consequences of gaba agonists. All of the evidence is weak at best and only for short term use but doesn't account for whether "short term use" means that people in real life actually stop taking them. Finally, the primary end points are all sleep time/quality, but there is no evidence of benefit on the secondary effects of insomnia which is what we actually care about! In fact, for some of the drugs you're more likely to have daytime somnolence than on placebo (hi Belsomra). So you can't sleep? Let's make you extra tired!
Remember, even clinical specialists have an inherent conflict of interest. If you're a sleep specialist and don't have anything to prescribe for many of your patients, do you stay in business? Can you make the same living doing CBTi only?