Is temazepam (temazepam) effective for insomnia?

Temazepam for Insomnia Treatment

Temazepam is effective for both sleep onset and sleep maintenance insomnia in adults, with evidence supporting its use at a 15 mg dose. 1

Efficacy of Temazepam

Temazepam is a benzodiazepine that has demonstrated effectiveness for treating insomnia with the following benefits:

• Sleep onset improvement: Reduces subjective and possibly objective sleep latency 1
• Sleep maintenance improvement: Increases total sleep time and reduces wake time after sleep onset 1
• Dosage considerations:
  • 15 mg dose is recommended by clinical guidelines for most adults 1
  • 7.5 mg may be effective in elderly patients 2

The American Academy of Sleep Medicine clinical practice guideline specifically suggests temazepam for both sleep onset and sleep maintenance insomnia, based on trials using 15 mg doses 1.

Evidence Quality and Strength of Recommendation

The recommendation for temazepam is classified as "weak" according to the GRADE methodology, with the quality of evidence rated as moderate due to some imprecision in the available data 1. This means:

• Benefits outweigh potential harms
• The majority of patients would likely use this treatment over no treatment, though many might not 1

Limitations and Considerations

Several important limitations should be noted:

• Insufficient evidence in ACP guidelines: The American College of Physicians 2016 guideline notes insufficient evidence on the effectiveness of benzodiazepine hypnotics including temazepam 1

• Short-term use only: FDA approval is for short-term use (4-5 weeks), not extended periods 1

  • Patients should be reevaluated if insomnia doesn't improve within 7-10 days 1

• Absorption timing: Temazepam has slower absorption compared to other hypnotics, which may limit its effectiveness for sleep onset insomnia in some patients 3

• Rebound insomnia risk: Studies show temazepam can cause rebound insomnia upon discontinuation, though to a lesser degree than triazolam 4

• Special populations: Lower doses (7.5-15 mg) are recommended for elderly or debilitated patients 3, 2

Safety Profile

Temazepam appears to have a relatively favorable safety profile compared to some other hypnotics:

• Limited adverse effects: Studies report infrequent adverse events (7.8% in one study) with mild severity that decreased over time 5

• Reduced morning impairment: Temazepam has a half-life of 10-15 hours with no active metabolites, potentially causing fewer "hangover" effects than longer-acting benzodiazepines 3, 6

• Cautions:

  • Higher doses (30 mg or more) may impair morning psychomotor and cognitive function 6
  • Benzodiazepines should be used with caution in older adults and those with cognitive impairment 7

Alternative Approaches

Before considering temazepam, note that:

• CBT-I is first-line: Cognitive behavioral therapy for insomnia is recommended as first-line treatment before pharmacological options 1

• Combination therapy: Adding CBT-I to temazepam treatment may reduce the amount of medication needed while maintaining efficacy 5

• Other pharmacological options with evidence for insomnia include:

  • Non-benzodiazepine hypnotics (eszopiclone, zaleplon, zolpidem)
  • Orexin receptor antagonists (suvorexant)
  • Doxepin (for sleep maintenance)
  • Ramelteon (for sleep onset) 1

Bottom Line

Temazepam at 15 mg is an effective option for both sleep onset and maintenance insomnia, with moderate quality evidence supporting its use. However, it should be used for short-term treatment only, with appropriate consideration of potential adverse effects and after trying non-pharmacological approaches like CBT-I first.