Poor Sleep Predicts Chronic Benzodiazepine Use


I met my first elderly benzo addict in 1979. Apparently, nothing has changed or has gotten worse…

New benzodiazepine users with poor sleep quality were more likely to stay on these agents for long periods , researchers reported.

The analysis, which looked at nearly 580 older adults (mean age 78) starting on benzodiazepines, found that those with very bad sleep quality at baseline had more than four-fold higher odds of becoming long-term users compared with people with very good sleep (adjusted OR 4.05, 95% CI 1.44-11.43, P=0.008), Lauren Gerlach, DO, of the University of Michigan in Ann Arbor, and colleagues wrote in a research letter appearing in JAMA Internal Medicine.

Another risk factor for conversion to long-term use was a larger number of days supplied at initial dispensing (aOR 1.94, 95% CI 1.52-2.47, P<0.001). During the follow-up period, this link only seemed to become more apparent: patients who went on to become long-term users were prescribed 233 days’ worth of pills on average, compared with an average 89-day supply for those whose use remained short.

Other factors tied to an increased chance of long-term benzodiazepine use also included being white (aOR 4.19, 95% CI 1.51-11.59, P=0.006).

On the other hand, Gerlach’s group found that neither high anxiety levels nor a diagnosis of major depression were tied to increased risk of long-term benzodiazepine use. Use of other psychotropic medications, such as cognitive enhancers including cholinesterase inhibitors or memantine, or being prescribed opioids also weren’t linked to any increased odds of long-term versus short-term benzodiazepine use. Similarly, initial prescription of a long-acting benzodiazepine didn’t raise the odds of long-term use.

Most clinical practice guidelines recommend against prescribing benzodiazepines for longer than 4 weeks for new users, Gerlach and colleagues noted approvingly.

“[P]rescribers should ‘begin with the end in mind,'” they wrote, adding that physicians must “immediately engage patients in discussion regarding the expected (brief) length of treatment, particularly when prescribed for insomnia.”

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