INSOMNIA IN JAIL INMATES: A STUDY FROM THE SUB HIMALAYAN REGION OF NORTH INDIA.

Insomnia has been defined as having difficulty in initiating or maintaining sleep, or experiencing early morning awakenings, with resultant daytime impairment.1,2,3 Insomnia is a serious condition that affects over 60% of the prison population and has been associated with aggression, anger, impulsivity, suicidality, and increased prison health care use. 4 Hence management of insomnia in jail inmates become important. Benzodiazepines are commonly prescribed medications for insomnia. According to the FDA, fast-onset, short acting benzodiazepines should not be prescribed for more than five consecutive weeks, to avoid the risk of dependency. Though in reality, they are commonly used for longer durations which can lead to complications.5 Mirtazapine is an antidepressant drug with US Food and Drug Administration approval for the management of major depressive disorder. At lower doses mirtazapine is often used for management of insomnia. Methods: This study consisted of a sample of 40 jail inmates who were on benzodiazepine for insomnia. Benzodiazepine was cross tapered with mirtazapine. Insomnia was studied using daily sleep diary which was assessed weekly. Results: The study identified that mirtazapine at lower dose can be used for long term management of insomnia. Discussion: In long term management of insomnia not only medications but sleep hygiene, regular exercise and education regarding the effects of long term use of sedatives should be included as is done in general population. Keywords: jail inmates, insomnia, mirtazapine, benzodiazepine.