This guideline does not apply to those with other sleep disorders or untreated anxiety , depression , or other physical or mental health conditions that might be causing or aggravating insomnia .
Benzodiazepine receptor agonists are associated with harms , and therapeutic effects might be short term .
Tapering BZRAs improves cessation rates compared with usual care without serious harms .
Patients might be more amenable to deprescribing conversations if they underst and the rationale ( potential for harm ) , are involved in developing the tapering plan , and are offered behavioural advice .
OBJECTIVE To develop an evidence -based guideline to help clinicians make decisions about when and how to safely taper and stop benzodiazepine receptor agonists ( BZRAs ) ; to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development , review , and endorsement processes .
Efficacy of an Internet-based behavioral intervention for adults with insomnia.
CONTEXT Insomnia is a major health problem with significant psychological , health , and economic consequences . However , availability of one of the most effective insomnia treatments , cognitive behavioral therapy , is significantly limited . The Internet may be a key conduit for delivering this intervention . OBJECTIVE To evaluate the efficacy of a structured behavioral Internet intervention for adults with insomnia . DESIGN , SETTING , AND PARTICIPANTS Forty-five adults were r and omly assigned to an Internet intervention  ( n = 22 ) or wait-list control group  ( n = 23 ) . Forty-four eligible participants ( mean [ SD ] age , 44.86 [ 11.03 ] years ; 34 women ) who had a history of sleep difficulties longer than 10 years on average ( mean [ SD ] , 10.59 [ 8.89 ] years ) were included in the analyses . INTERVENTION The Internet intervention is based on well-established face-to-face cognitive behavioral therapy incorporating the primary components of sleep restriction , stimulus control , sleep hygiene , cognitive restructuring , and relapse prevention . MAIN OUTCOME MEASURES The Insomnia Severity Index and daily sleep diary data were used to determine changes in insomnia severity and the main sleep variables , including wake after sleep onset and sleep efficiency . RESULTS Intention-to-treat analyses showed that scores on the Insomnia Severity Index significantly improved from 15.73 ( 95 % confidence interval [ CI ] , 14.07 to 17.39 ) to 6.59 ( 95 % CI , 4.73 to 8.45 ) for the Internet group but did not change for the control group ( 16.27 [ 95 % CI , 14.61 to 17.94 ] to 15.50 [ 95 % CI , 13.64 to 17.36 ] ) ( F(1,42 ) = 29.64 ; P < .001 ) . The Internet group maintained their gains at the 6-month follow-up . Internet participants also achieved significant decreases in wake after sleep onset ( 55 % [ 95 % CI , 34 % to 76 % ] ) and increases in sleep efficiency ( 16 % [ 95 % CI , 9 % to 22 % ] ) compared with the nonsignificant control group changes of wake after sleep onset ( 8 % [ 95 % CI , -17 % to 33 % ) and sleep efficiency ( 3 % ; 95 % CI , -4 % to 9 % ) . CONCLUSIONS Participants who received the Internet intervention for insomnia significantly improved their sleep , whereas the control group did not have a significant change . The Internet appears to have considerable potential in delivering a structured behavioral program for insomnia . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00328250
This guideline does not apply to those with other sleep disorders or untreated anxiety , depression , or other physical or mental health conditions that might be causing or aggravating insomnia .
Benzodiazepine receptor agonists are associated with harms , and therapeutic effects might be short term .
Tapering BZRAs improves cessation rates compared with usual care without serious harms .
Patients might be more amenable to deprescribing conversations if they underst and the rationale ( potential for harm ) , are involved in developing the tapering plan , and are offered behavioural advice .
OBJECTIVE To develop an evidence -based guideline to help clinicians make decisions about when and how to safely taper and stop benzodiazepine receptor agonists ( BZRAs ) ; to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development , review , and endorsement processes .