{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T10:42:30Z","timestamp":1776336150662,"version":"3.51.2"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2019,1,26]],"date-time":"2019-01-26T00:00:00Z","timestamp":1548460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012363","name":"Saudi Arabia Cultural Bureau in London","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100012363","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Despite the risks associated with hypnotics and their recent increased use in Saudi Arabia, there are no specific national guidelines for using these medicines to treat insomnia nor are there any data on how these medicines are currently prescribed. There is the potential, however, that some physicians might be adhering to the United States guidelines. The current audit study was aimed to assess the current practice in treating insomnia with hypnotics in Saudi Arabia, and to evaluate its agreement with the US guidelines. The audit was conducted using data collected between April 2012 and March 2017 at King Fahad Central Hospital (KFCH; Jazan), of patients who were either prescribed benzodiazepines (BZDs) or Z-drugs or diagnosed with insomnia. The audit criteria followed two US guidelines for the management of insomnia in adults. Data included documented diagnosis, use of CBT-I (Cognitive Behavioral Therapy for Insomnia), use of BZDs and Z-drugs including treatment regimen, and whether physicians prescribed anti-histamines for insomnia. The data were analyzed using STATA 14 after transcription to a MS XL file. Of the 504 records reviewed, 379 patients (75%) were prescribed BZDs or Z-drugs; only 182 (48%) of them had clearly documented indications for their use. Three hundred and seven patients (60%) were diagnosed with insomnia; none of them received CBT-I as initial treatment. No patients on long-term use of hypnotics were reviewed by their physicians after they began using the medication. More than 43% of patients were prescribed anti-histamines for insomnia. No records met all (or even six) of the seven criteria. KFCH physicians do not follow US guidelines. Therefore, the Ministry of Health (MOH) should improve its administrative systems including documentation, and instead of using international guidelines that are seldom followed, physicians should be trained in prescribing hypnotics and national guidelines need to be developed.<\/jats:p>","DOI":"10.3390\/pharmacy7010015","type":"journal-article","created":{"date-parts":[[2019,1,29]],"date-time":"2019-01-29T11:27:52Z","timestamp":1548761272000},"page":"15","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Current Clinical Practice for the Use of Hypnotics to Manage Primary Insomnia in Adults in a Tertiary Hospital in Saudi Arabia: An Audit Study"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5579-5056","authenticated-orcid":false,"given":"Ali","family":"Dobia","sequence":"first","affiliation":[{"name":"School of Pharmacy, University of Reading, Reading, Berkshire RG6 6AP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6086-5730","authenticated-orcid":false,"given":"Kath","family":"Ryan","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of Reading, Reading, Berkshire RG6 6AP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Grant","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of Reading, Reading, Berkshire RG6 6AP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1706-6167","authenticated-orcid":false,"given":"Ahmed","family":"BaHammam","sequence":"additional","affiliation":[{"name":"University Sleep Disorders Center, College of Medicine, King Saud University, P.O. Box 225503, Riyadh 11324, Saudi Arabia"},{"name":"The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation, Riyadh 11633, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1001\/jamapsychiatry.2014.1763","article-title":"Benzodiazepine use in the United States","volume":"72","author":"Olfson","year":"2015","journal-title":"JAMA Psychiatry"},{"key":"ref_2","unstructured":"NICE (2016, June 20). Hypnotics. Available online: https:\/\/www.nice.org.uk\/advice\/ktt6."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"487","DOI":"10.5664\/jcsm.27286","article-title":"Clinical guideline for the evaluation and management of chronic insomnia in adults","volume":"4","author":"Broch","year":"2008","journal-title":"J. Clin. Sleep Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"307","DOI":"10.5664\/jcsm.6470","article-title":"Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine Clinical Practice Guideline","volume":"13","author":"Sateia","year":"2017","journal-title":"J. Clin. Sleep Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1111\/jsr.12594","article-title":"European guideline for the diagnosis and treatment of insomnia","volume":"26","author":"Riemann","year":"2017","journal-title":"J. Sleep Res."},{"key":"ref_6","unstructured":"NINC (2016, June 15). Guidance on the Use of Zaleplon, Zolpidem and Zopiclone for the Short Term Management of Insomnia: Technology Appraisal Guidance. Available online: https:\/\/www.nice.org.uk\/guidance\/ta77\/chapter\/1-Guidance."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"125","DOI":"10.7326\/M15-2175","article-title":"Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline from the American College of Physicians","volume":"165","author":"Qaseem","year":"2016","journal-title":"Ann. Intern. Med."},{"key":"ref_8","unstructured":"ISS (2016, July 12). The first Guidelines for the Assessment and Management of Patients with Sleep Disorders. Available online: http:\/\/www.irishsleepsociety.org\/guidelines.htm."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1192\/bjp.bp.114.149252","article-title":"Misuse of benzodiazepines and Z-drugs in the UK","volume":"205","author":"Kapil","year":"2014","journal-title":"Br. J. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"417","DOI":"10.3399\/bjgp08X299290","article-title":"Magic bullets for insomnia? Patients\u2019 use and experiences of newer (Z drugs) versus older (benzodiazepine) hypnotics for sleep problems in primary care","volume":"58","author":"Siriwardena","year":"2008","journal-title":"Br. J. Gen. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1016\/S0924-9338(10)70981-0","article-title":"Audit on use of hypnotics for insomnia in comparison with national institute of clincal excellence guidelines","volume":"25","author":"Singh","year":"2010","journal-title":"Eur. Psychiatry"},{"key":"ref_12","first-page":"84","article-title":"An audit of prescribing practices for benzodiazepines and Z-drugs","volume":"108","author":"Cadogan","year":"2015","journal-title":"Ir. Med. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/1817-1737.74269","article-title":"Sleep medicine in Saudi Arabia: Current problems and future challenges","volume":"6","author":"Bahammam","year":"2011","journal-title":"Ann. Thorac. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/1817-1737.105710","article-title":"Saudi regulations for the accreditation of sleep medicine physicians and technologists","volume":"8","author":"BaHammam","year":"2013","journal-title":"Ann. Thorac. Med."},{"key":"ref_15","first-page":"899","article-title":"Integration of mental health care into primary care. Preliminary observations of continuing implementation phase","volume":"22","author":"Qureshi","year":"2001","journal-title":"Saudi Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4236\/ojpsych.2014.42016","article-title":"Mental health care in Saudi Arabia: Past, present and future","volume":"4","author":"Koenig","year":"2014","journal-title":"OJPSYCH"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"27","DOI":"10.26719\/1999.5.1.27","article-title":"Psychotropic Drugs Prescriptions in Al-Qassim Region, Saudi Arabia","volume":"5","author":"Qureshi","year":"1999","journal-title":"East. Mediterr. Health J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1111\/jep.12658","article-title":"Assessment of implementability of an adapted clinical practice guideline for surgical antimicrobial prophylaxis at a tertiary care university hospital","volume":"23","author":"Altokhais","year":"2017","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_19","first-page":"794","article-title":"Healthcare system in Saudi Arabia: An analysis of structure, total quality management and future challenges","volume":"2","author":"Albejaidi","year":"2010","journal-title":"JAPSS"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1136\/bmj.39527.628322.AD","article-title":"Audit: How to do it in practice","volume":"336","author":"Benjamin","year":"2008","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1503\/cmaj.150056","article-title":"Tertiary hospitals must provide general care","volume":"187","author":"Flegel","year":"2015","journal-title":"Can. Med. Assoc."},{"key":"ref_22","unstructured":"StataCorp (2015). Stata Statistical Software: Release 14, StataCorp LP."},{"key":"ref_23","unstructured":"Center for Substance Abuse Treatment (2004). Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/S0022-3956(02)00052-3","article-title":"Place of chronic insomnia in the course of depressive and anxiety disorders","volume":"37","author":"Ohayon","year":"2003","journal-title":"J. Psychiatr. Res."},{"key":"ref_25","unstructured":"Schaeffer, J. (2017, May 22). Poor Documentation: Why It Happens and How to Fix It. Available online: https:\/\/www.fortherecordmag.com\/archives\/0516p12.shtml."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"125","DOI":"10.5664\/jcsm.26304","article-title":"Hypnotics should not be considered for the initial treatment of chronic insomnia","volume":"1","author":"Stepanski","year":"2005","journal-title":"Con. JCSM"},{"key":"ref_27","unstructured":"Organization, W.H. (2018, October 28). Mental Health Atlas Country Profile. Available online: http:\/\/www.who.int\/mental_health\/evidence\/atlas\/profiles-2014\/sau.pdf."},{"key":"ref_28","unstructured":"Essential Medicines and Health Products Information Portal (2016, June 20). Ministry of Health Formulary (MOHF) Drug List. Available online: http:\/\/apps.who.int\/medicinedocs\/en\/d\/Js23157en\/."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s13181-013-0292-0","article-title":"The clinical and forensic toxicology of Z-drugs","volume":"9","author":"Gunja","year":"2013","journal-title":"J. Med. Toxicol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"837","DOI":"10.5664\/jcsm.6632","article-title":"Hypnotics and the risks of dementia","volume":"13","author":"James","year":"2017","journal-title":"JCSM"},{"key":"ref_31","first-page":"S31","article-title":"Perspectives on the management of insomnia in patients with chronic respiratory disorders","volume":"23","author":"George","year":"2000","journal-title":"Sleep"}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/7\/1\/15\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:28:44Z","timestamp":1760185724000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/7\/1\/15"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,26]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,3]]}},"alternative-id":["pharmacy7010015"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy7010015","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1,26]]}}}