Efficacy of Sleeping Without Pills (SWOP), an Online Drug Tapering Program
Efficacy of Sleeping Without Pills (SWOP), an Online Drug Tapering Program
The aims of the study are to determine whether an online drug tapering program can lead to
 successful drug tapering in hypnotic dependent insomnia and whether such tapering is
 associated with improved daytime functioning and sleep.
Insomnia is defined as difficulty with falling asleep, staying asleep, or early morning
 awakening. Chronic insomnia is estimated to affect 9-15% of the world's population. Lack of
 sleep increases a person's risk for many chronic diseases such as obesity, diabetes,
 cardiovascular disease, anxiety and depression. The two types of treatment available for
 chronic insomnia are cognitive behavioural therapy (CBT) and pharmacotherapy, the latter of
 which includes benzodiazepines and non-benzodiazepines.

 The use of hypnotic medications is intended to be prescribed as a short-term treatment of one
 or two weeks, however this is not the case most of the time. Hypnotic abuse and dependency
 are prevalent issues that increase with advancing age. With the regular intake of these
 substances comes many adverse effects such as sedation, cognitive and psychomotor effects,
 falls and other accidents. Relative to non-drug users, cognitive events are 5.0 times more
 likely, psychomotor events are 3.0 times more likely, and daytime fatigue is 4.0 times more
 likely among drug users. Both non-benzodiazepines and benzodiazepines have the potential for
 dependency and withdrawal, although zolpidem and other non-benzodiazepine hypnotic agents
 have become the preferred drugs to manage insomnia due to the lower side effect profile.
 Withdrawal symptoms are associated with a rapid dose decrease or abrupt discontinuance of
 medication. These symptoms include rebound insomnia, anxiety, memory and concentration
 impairments and in severe states, psychotic symptoms, delirium and epileptic seizures.

 A recent comparison of cost data associated with pharmacotherapy and cognitive behavioral
 therapy showed that CBT was significantly less costly than pharmacotherapy. Unfortunately,
 CBT is often not applied due to limited access to appropriately trained practitioners. The
 combination of equivalent efficacy, reduced costs, and favorable side-effect profile have
 made cognitive behavioural therapy (CBT) the preferred treatment for insomnia as evidenced by
 endorsements with the American Academy of Sleep Medicine. More recently, the delivery of CBT
 for insomnia has been enhanced to be provided through web-based portals. A number of
 web-based programs for insomnia have been developed with promising results. Some of these
 programs measured hypnotic use.

 The effect size associated with online CBT (without drug tapering component) on reducing
 hypnotic drug use has been small, and these studies have employed a mix of participants, only
 some of whom are interested in tapering with variable levels of motivation. Studies comparing
 CBT plus drug tapering with drug tapering alone using booklets and in-person sessions have
 found that such interventions are moderately effective in reducing dosage and frequency of
 sleep medication usage.

 The aims of the study are to determine whether an online drug tapering program (Sleeping
 without Pills; SWOP) can lead to successful drug tapering in hypnotic dependent insomnia
 (primary aim), and whether such tapering is associated with improved daytime functioning and
 sleep (secondary aims).
Inclusion Criteria:

 a) >= 18 years, b) access to high speed internet and computer, c) disturbance of sleep
 consisting of a delay in sleep onset, return to sleep or early morning awakening at least 3
 nights/week for at least 3 months in duration, d) at least one symptom of daytime
 impairment, use of medication to promote sleep, e) use of medication to promote sleep
 (either <= 1mg lorazepam, <= .5mg clonazepam, <= 7.5mg zopiclone, <= 50 mg
 trazodone/amitriptyline, f) interested in medication tapering.

 Exclusion Criteria:

 a) shift work, b) head injury, c) acute crisis, d) seizure disorder, e) use of psychotropic
 drugs for problems other than sleep, f) use of medication interfering with sleep, g)
 recreational drug use, h) symptoms suggestive of alternative sleep disorder that is
 untreated, i) elevated use of alcohol (> 14 beverages/week for males, >12 beverages per
 week for females)