Effect of midazolam, flunitrazepam, and placebo against midwinter insomnia in northern Norway

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Abstract
Outpatients (43) with midwinter insomnia (an early type insomnia commonly seen north of the Polar Circle when the sun stays below the horizon) were randomly allocated to 1 of 3 treatment groups, receiving either 15 mg midazolam, 1 mg flunitrazepam, or placebo, for 5 nights, double blind, after 3 nights without drug. In all 3 groups, this was followed by 5 nights on placebo (single blind). Several subjective sleep variables were recorded every morning, some variables also at noon. Placebo had practically no effect on any sleep variable. Both active drugs markedly improved sleep with regard to the following variables: sleep latency, number of awakenings, total duration of sleep, quality of sleep, total evaluation of sleep as well as feelings of drowsiness in the morning and at noon. In the withdrawal period, patients who had received active drug showed a deterioration of sleep on most variables, but not beyond the baseline level. A true rebound insomnia was not demonstrated. There was no significant difference in any of the variables between midazolam and flunitrazepam treatments. Side effects were reported by very few patients. Midazolam seems to be as effective as flunitrazepam in this type of insomnia, despite its much shorter biological half-life.