***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: INTRODUCTION The purpose of this guideline is to establish clinical practice recommendations for the pharmacologic treatment of chronic insomnia in adults , when such treatment is clinical ly indicated . Unlike previous meta-analyses , which focused on broad classes of drugs , this guideline focuses on individual drugs commonly used to treat insomnia . It includes drugs that are FDA -approved for the treatment of insomnia , as well as several drugs commonly used to treat insomnia without an FDA indication for this condition . This guideline should be used in conjunction with other AASM guidelines on the evaluation and treatment of chronic insomnia in adults . METHODS The American Academy of Sleep Medicine commissioned a task force of four experts in sleep medicine . A systematic review was conducted to identify r and omized controlled trials , and the Grading of Recommendations Assessment , Development , and Evaluation ( GRADE ) process was used to assess the evidence . The task force developed recommendations and assigned strengths based on the quality of evidence , the balance of benefits and harms , and patient values and preferences . Literature review s are provided for those pharmacologic agents for which sufficient evidence was available to establish recommendations . The AASM Board of Directors approved the final recommendations . RECOMMENDATIONS The following recommendations are intended as a guideline for clinicians in choosing a specific pharmacological agent for treatment of chronic insomnia in adults , when such treatment is indicated . Under GRADE , a STRONG recommendation is one that clinicians should , under most circumstances , follow . A WEAK recommendation reflects a lower degree of certainty in the outcome and appropriateness of the patient-care strategy for all patients , but should not be construed as an indication of ineffectiveness . GRADE recommendation strengths do not refer to the magnitude of treatment effects in a particular patient , but rather , to the strength of evidence in published data . Downgrading the quality of evidence for these treatments is predictable in GRADE , due to the funding source for most pharmacological clinical trials and the attendant risk of publication bias ; the relatively small number of eligible trials for each individual agent ; and the observed heterogeneity in the data . The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient , available diagnostic tools , accessible treatment options , and re sources . We suggest that clinicians use suvorexant as a treatment for sleep maintenance insomnia ( versus no treatment ) in adults . ( WEAK ) . We suggest that clinicians use eszopiclone as a treatment for sleep onset and sleep maintenance insomnia ( versus no treatment ) in adults . ( WEAK ) . We suggest that clinicians use zaleplon as a treatment for sleep onset insomnia ( versus no treatment ) in adults . ( WEAK ) . We suggest that clinicians use zolpidem as a treatment for sleep onset and sleep maintenance insomnia ( versus no treatment ) in adults . ( WEAK ) . We suggest that clinicians use triazolam as a treatment for sleep onset insomnia ( versus no treatment ) in adults . ( WEAK ) . We suggest that clinicians use temazepam as a treatment for sleep onset and sleep maintenance insomnia ( versus no treatment ) in adults . ( WEAK ) . We suggest that clinicians use ramelteon as a treatment for sleep onset insomnia ( versus no treatment ) in adults . ( WEAK ) . We suggest that clinicians use doxepin as a treatment for sleep maintenance insomnia ( versus no treatment ) in adults . ( WEAK ) . We suggest that clinicians not use trazodone as a treatment for sleep onset or sleep maintenance insomnia ( versus no treatment ) in adults . ( WEAK ) . We suggest that clinicians not use tiagabine as a treatment for sleep onset or sleep maintenance insomnia ( versus no treatment ) in adults . ( WEAK ) . We suggest that clinicians not use  diphenhydramine  as a treatment for sleep onset and sleep maintenance insomnia ( versus no treatment ) in adults . ( WEAK ) . We suggest that clinicians not use  melatonin  as a treatment for sleep onset or sleep maintenance insomnia ( versus no treatment ) in adults . ( WEAK ) . We suggest that clinicians not use tryptophan as a treatment for sleep onset or sleep maintenance insomnia ( versus no treatment ) in adults . ( WEAK ) . We suggest that clinicians not use  valerian  as a treatment for sleep onset or sleep maintenance insomnia ( versus no treatment ) in adults . ( WEAK ) BACKGROUND Chronic sleep-onset insomnia is a prevalent health complaint in adults . Although behavioral and pharmacological therapies have been shown to be effective for insomnia , no placebo-controlled trials have evaluated their separate and combined effects for sleep-onset insomnia . The objective of this study was to evaluate the clinical efficacy of behavioral and pharmacological therapy , singly and in combination , for chronic sleep-onset insomnia . METHODS This was a r and omized , placebo-controlled clinical trial that involved 63 young and middle-aged adults with chronic sleep-onset insomnia . Interventions included cognitive behavior therapy ( CBT ) , pharmacotherapy , or combination therapy compared with placebo . The main outcome measures were sleep-onset latency as measured by sleep diaries ; secondary measures included sleep diary measures of sleep efficiency and total sleep time , objective measures of sleep variables ( Nightcap sleep monitor recorder ) , and measures of daytime functioning . RESULTS In most measures , CBT was the most sleep effective intervention ; it produced the greatest changes in sleep-onset latency and sleep efficiency , yielded the largest number of normal sleepers after treatment , and maintained therapeutic gains at long-term follow-up . The combined treatment provided no advantage over CBT alone , whereas pharmacotherapy produced only moderate improvements during drug administration and returned measures toward baseline after drug use discontinuation . CONCLUSIONS These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia . Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large numbers of patients with insomnia Objective To evaluate the association between use of benzodiazepines and incident dementia . Design Prospect i ve , population based study . Setting PAQUID study , France . Participants 1063 men and women ( mean age 78.2 years ) who were free of dementia and did not start taking benzodiazepines until at least the third year of follow-up . Main outcome measures Incident dementia , confirmed by a neurologist . Results During a 15 year follow-up , 253 incident cases of dementia were confirmed . New use of benzodiazepines was associated with an increased risk of dementia ( multivariable adjusted hazard ratio 1.60 , 95 % confidence interval 1.08 to 2.38 ) . Sensitivity analysis considering the existence of depressive symptoms showed a similar association ( hazard ratio 1.62 , 1.08 to 2.43 ) . A secondary analysis pooled cohorts of participants who started benzodiazepines during follow-up and evaluated the association with incident dementia . The pooled hazard ratio across the five cohorts of new benzodiazepine users was 1.46 ( 1.10 to 1.94 ) . Results of a complementary nested case-control study showed that ever use of benzodiazepines was associated with an approximately 50 % increase in the risk of dementia ( adjusted odds ratio 1.55 , 1.24 to 1.95 ) compared with never users . The results were similar in past users ( odds ratio 1.56 , 1.23 to 1.98 ) and recent users ( 1.48 , 0.83 to 2.63 ) but reached significance only for past users . Conclusions In this prospect i ve population based study , new use of benzodiazepines was associated with increased risk of dementia . The result was robust in pooled analyses across cohorts of new users of benzodiazepines throughout the study and in a complementary case-control study . Considering the extent to which benzodiazepines are prescribed and the number of potential adverse effects of this drug class in the general population , indiscriminate widespread use should be caution ed against BACKGROUND Use of sleep medications as a result of hospitalization among older adults is common and has been shown to result in chronic use and increased risks for adverse effects such as falls and cognitive decline . However , few studies have explored in-hospital sleep medication use or disuse as a possible factor related to subsequent home use . OBJECTIVE The aim of this study was to examine changes in sleep medication use pre- to post-hospitalization as a function of in-hospital use . METHODS The study was design ed as a prospect i ve cohort study , and included 485 acute medical patients aged 70 years and older , hospitalized in a large , Israeli , teaching medical centre .  Sleep medication use was assessed by patient interviews regarding patterns of use prior to , during and at 1 and 3 months after discharge . Post-discharge using patterns were assessed as a function of in-hospital discontinuation or initiation of sleep medications ; background demographic and clinical characteristics were assessed as well . Logistic regressions were modelled separately for discontinuation and initiation of sleep medication use at each follow-up . RESULTS Of those patients who used sleep medications prior to admission , 37 ( 18 % of 206 prior users ) discontinued use during the hospital stay . Non-use of sleep medications during hospitalization was the main significant characteristic associated with post-hospitalization discontinuation among prior users , when comparing patients who continued with those who discontinued using sleep medications in bivariate analyses . Discontinuation was associated with an adjusted odds ratio ( AOR , adjusted for cognitive status ) of 3.91 ( 95 % confidence interval [ CI ] 1.64 , 9.30 ) for non-use at the 1-month follow-up . Of those who did not use sleep medications prior to admission , 39 ( 14 % of 279 non-prior users ) initiated use during hospitalization . Again , sleep medication initiation at time of hospitalization was the main correlate of change in post-hospitalization medication use status , when comparing post-discharge users and non-users , among the non-prior users . Hospital initiation of sleep medications  was associated with an AOR ( adjusted for levels of education and morbidity , readmission , and functional status ) of 4.65 ( 95 % CI 1.95 , 11.09 ) for post-discharge use . Similar results were obtained for the 3-month follow-up , reaching significance levels only for the discontinuation group . CONCLUSIONS Though overall prevalence rates of sleep medication use pre- and post-hospitalization are fairly similar , rigorous scrutiny of the findings demonstrates that in-hospital sleep medication use and disuse may be a significant turning point both for initiation and discontinuation of sleep medications , especially in the short post-discharge time frame . Thus , in-hospital sleep medication prescribing policies should acknowledge the potential for changes in the post-discharge sleep medication regimen BACKGROUND Despite ongoing concern about adverse effects and dependence on benzodiazepines , approximately 2 % of Australians are still taking them on a regular basis . The aim of this study was to evaluate the effectiveness of an educational outreach or ' academic detailing ' program about prescribing of benzodiazepines . METHOD In this r and omised trial general practice registrars ( n = 157 ) in New South Wales were allocated to an intervention group ( n = 79 ) , which received a 20 minute educational outreach visit ; or a control group ( n = 78 ) which received an intervention on an unrelated topic .  Prescribing behaviour was monitored by a pre-intervention and two post-intervention practice activity surveys . MAIN OUTCOME MEASURES These were the rate of benzodiazepine prescribing for all indications , for anxiety and for sleep disorders . RESULTS Overall benzodiazepine prescribing by the intervention group declined from 2.3 to 1.7 per 100 encounters , while the control group also declined from 2.2 to 1.6 per 100 encounters . Analysis of variance showed this was a significant drop over time ( P = 0.042 ) but there was no difference between groups ( P = 0.99 ) . The prescribing decrease observed was in continuing rather than initial prescriptions . CONCLUSIONS A marked decrease in benzodiazepine prescribing was seen over the course of the study in both intervention and control groups but no differential effect due to the educational outreach visit was found BACKGROUND the STOPP criteria advise against the use of long-acting benzodiazepines ( LBs ) . OBJECTIVE to study whether LBs are associated with a higher fall risk than short-acting benzodiazepines ( SBs ) ( elimination half-life ≤ 10 h ) . METHODS we used base-line data and prospect i ve fall follow-up from the Longitudinal Aging Study Amsterdam , a longitudinal cohort study including 1,509 community-dwelling older persons ( Study 1 ) and from a separate fall prevention study with 564 older persons after a fall ( Study 2 ) .  Time to the first fall after inclusion and number of falls in the first year after inclusion were the primary endpoints . RESULTS both in Study 1 and Study 2 the use of SBs was associated with time to the first fall , hazard ratio ( HR ) 1.62 ( 95 % CI : 1.03 - 2.56 ) and HR 1.64 ( 95 % CI : 1.19 - 2.26),respectively . LBs were not significantly associated with time to first fall , HR 1.40 ( 0.85 - 2.31 ) and HR 1.08 ( 0.72 - 1.62 ) . In both studies , the 
    Output:
    
Restrictive prescription rules were effective to reduce the consumption of targeted SHs but led to a switch to other non-recommended SHs .
Among educational interventions , only 3 studies out of 7 reported positive results of mono-faceted interventions ; whereas , 13 out of the 16 multi-faceted interventions were reported as efficient : particularly , the active involvement of healthcare professionals and patients and the spread of information through mass media were successful .
Educational multifaceted studies are presented as the most efficient .