A new study published in the Journal of Clinical Sleep Medicine has found that the medication clonidine is more effective and safer than zopiclone for treating insomnia in people with chronic pain.
Key findings:
- Clonidine provided better pain relief than zopiclone.
- Clonidine helped patients fall asleep faster.
- Patients felt more rested after taking clonidine compared to zopiclone.
- Overall sleep quality was rated higher with clonidine.
- Clonidine resulted in fewer side effects than zopiclone.
Source: J Clin Sleep Med 2022
Insomnia, chronic pain, clonidine
Insomnia is a common problem for people suffering from chronic pain, contributing to a vicious cycle of worsening pain and poor sleep quality.
Medications are often used to help chronic pain patients sleep better, but finding the right drug can be challenging.
The sedative hypnotic zopiclone is frequently prescribed, but it carries risks of side effects.
Now, new research indicates the medication clonidine may be a safer, more effective option for treating insomnia in chronic pain patients.
Clonidine is commonly used to treat high blood pressure, but it also has sedative properties that can promote sleep.
A team of Canadian researchers conducted the first major study comparing zopiclone and clonidine for insomnia treatment in chronic pain patients.
Their results show clonidine outperformed zopiclone across several key measures of sleep quality and pain relief.
Clonidine for Insomnia in Chronic Pain Study
The study was conducted at a pain clinic in Canada from May 2020 to April 2021.
It included 160 chronic pain patients who had been taking zopiclone regularly for insomnia.
- Patients were prescribed alternating doses of zopiclone and clonidine to take each night over a 3-week period.
- They tracked ratings of sleep quality, pain levels, and side effects using a sleep diary.
- 150 patients completed the full 3-week crossover trial.
- Data analysis compared the efficacy and side effects of clonidine vs. zopiclone.
All patients in the study had severe chronic pain and insomnia despite pain management treatment.
Most were middle-aged adults and the majority were female and obese.
Clonidine Provided Better Pain Relief
The first key finding was that clonidine reduced patients’ pain levels more than zopiclone.
- Pain scores were significantly lower on nights when patients took clonidine rather than zopiclone.
- This suggests clonidine has analgesic properties that can augment pain relief.
- Treating pain is crucial for improving sleep in chronic pain patients.
These results indicate clonidine may relieve pain and promote sleep through separate mechanisms.
This is an advantage over zopiclone, which primarily acts as a sedative.
Clonidine Helped Patients Fall Asleep Faster
Patients reported falling asleep quicker after taking clonidine compared to zopiclone.
- With clonidine 0.2mg, patients fell asleep in 25 minutes on average.
- With zopiclone, patients took 40-45 minutes on average to fall asleep.
- The faster onset of sleep with clonidine was statistically significant.
Falling asleep faster is a major benefit for insomnia patients who struggle to initially drift off.
The data suggests clonidine works faster than zopiclone at the beginning of the night.
Patients Felt More Rested After Taking Clonidine
Patients rated feeling more rested in the mornings after taking clonidine versus zopiclone.
- The score for feeling rested was used to gauge sleep medication efficacy.
- Morning restedness was significantly higher with clonidine than zopiclone.
- The 0.2mg dose of clonidine resulted in the highest restedness ratings.
These ratings indicate patients achieved higher quality sleep with fewer disruptions when using clonidine.
Feeling restored after a night’s sleep is a key treatment goal for insomnia.
Overall Sleep Quality Was Higher with Clonidine
Patients gave higher scores for overall sleep quality on nights when they took clonidine instead of zopiclone.
- Overall sleep quality depended on factors like time to fall asleep, restfulness, and disruptions.
- The total sleep quality score was significantly better with clonidine.
- Clonidine 0.2mg provided optimal overall sleep quality.
Achieving high quality sleep is the ultimate objective for insomnia treatment. The data suggests clonidine consistently outperforms zopiclone in this regard.
Clonidine Resulted in Fewer Side Effects
The study also tracked the incidence of side effects from each medication.
Clonidine was much better tolerated overall than zopiclone.
Some key differences in side effect rates:
- Amnesia occurred in 60-80% of patients on zopiclone versus only 1-5% on clonidine.
- Hallucinations and confusion only occurred with zopiclone.
- Collapse, falls and coordination problems were also exclusive to zopiclone.
- The only notable side effect higher with clonidine was dry mouth (10-20% incidence).
The most dangerous potential adverse effects like cognitive dysfunction, motor impairment and collapse were virtually absent with clonidine.
In contrast, zopiclone carried risks of disorientation, instability and injury.
The more favorable safety profile of clonidine is a significant advantage for insomnia therapy.
Study Limitations
While promising, there are some limitations with this research that are important to consider:
- Sample size was relatively small at 150 patients.
- It was conducted at a single pain clinic, which may not represent all populations.
- There was no placebo control group for comparison.
- The crossover design may have had carryover effects between treatments.
More studies are needed to confirm and expand on these initial findings.
However, the results strongly suggest clonidine can improve key outcomes like sleep quality, pain relief, and safety in chronic pain patients struggling with insomnia.
Key Takeaways: Clonidine for Sleep
This groundbreaking study provides evidence that clonidine is more beneficial than zopiclone for treating insomnia in the setting of chronic pain.
Several key implications:
- Clonidine demonstrated better overall sleep quality, faster onset, and greater feelings of restfulness.
- Clonidine additionally provided superior pain relief, suggesting dual therapeutic effects.
- Clonidine resulted in fewer and less severe side effects than zopiclone.
- A higher dose of 0.2mg clonidine conferred greater benefits for sleep.
- Clonidine may promote sleep through mechanisms beyond sedation.
In summary, this research indicates clonidine is underutilized as a sleep aid in chronic pain patients.
Clonidine appears more efficacious and safer than zopiclone while enhancing analgesia.
These results could influence clinical practice to use clonidine more widely for insomnia related to chronic pain conditions.
References
- Study: Clonidine is better than zopiclone for insomnia treatment in chronic pain patients
- Authors: Bamgbade et al. (2022)
