P34: Sleep Monitoring-Assisted Discontinuation of Sleeping Pills in an Older Patient with insomnia: A Case Report

Abstract

Objectives: This study evaluates the use of sleep monitoring to discontinue sleeping pills in a patient with insomnia and neurodegenerative conditions, presenting a non-pharmacological approach to managing sleepdisorders.

Methods: This case report involves a 72-year-old woman with Progressive Supranuclear Palsy who was unable to sleep without sleeping pills. The patient lived alone, had some trouble speaking, and her MMSE score was 25/30. Medical records were reviewed from her initial visit to Hospital A until the cessation of sleeping pill use. Sleep was monitored using a non-wearable sheet-type device (Nemuri SCAN, Paramount Bed Co., Ltd.) placed under the mattress, providing long-term data. The study was conducted with approval from the Osaka University Hospital Ethics Review Committee.

Results: The patient had been unable to sleep since visiting her previous doctor and had tried various medications, including Suvorexant, Brotizolam, and Triazolam, none of which were effective. On her first visit to Hospital A, she was prescribed 8 mg of Ramelteon but still could not sleep. One week later, 15 mg of Brotizolam was added, allowing her to sleep with the combination of the two medications. A few months later, she experienced insomnia again due to daytime napping. Despite efforts to curb her naps, her condition persisted. Consequently, 0.25 mg of Clonazepam was added, and she was able to sleep with the three medications. After that, the patient began sleep monitoring using the Nemuri SCAN device and the monitoring indicated a consistent sleep rhythm with few awakenings, prompting her doctor to consider reducing her medication. A few months after starting sleep monitoring, the sleep monitoring results remained stable, with a constant sleep rhythm and few awakenings, leading to the discontinuation of 0.25 mg of Clonazepam and 15 mg of Brotizolam. Subsequent sleep monitoring continued to show stable results, allowing the discontinuation of 8 mg of Ramelteon six months after starting sleep monitoring.

Conclusions: This case highlights the importance of cautious sleep medication use in older and neurodegenerative patients, demonstrating benefits of alternative strategies like using non- wearable sleep monitoring device.