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 .
Predictors of Long-Term Benzodiazepine Abstinence in Participants of a Randomized Controlled Benzodiazepine Withdrawal Program
Objective : To identify predictors of resumed benzodiazepine use after participation in a benzodiazepine discontinuation trial . Method : We performed multiple Cox regression analyses to predict the long-term outcome of a 3-condition , r and omized , controlled benzodiazepine discontinuation trial in general practice . Results : Of 180 patients , we completed follow-up for 170 ( 94 % ) . Of these , 50 ( 29 % ) achieved long-term success , defined as no use of benzodiazepines during follow-up . Independent predictors of success were as follows : offering a taper-off program with group therapy ( hazard ratio [ HR ] 2.4 ; 95 % confidence interval [ CI ] , 1.5 to 3.9 ) or without group therapy ( HR 2.9 ; 95%CI , 1.8 to 4.8 ) ; a lower daily benzodiazepine dosage at the start of tapering off ( HR 1.5 ; 95%CI , 1.2 to 1.9 ) ; a substantial dosage reduction by patients themselves just before the start of tapering off ( HR 2.1 ; 95%CI , 1.4 to 3.3 ) ; less severe benzodiazepine dependence , as measured by the Benzodiazepine Dependence Self-Report Question naire Lack of Compliance subscale ( HR 2.4 ; 95%CI , 1.1 to 5.2 ) ; and no use of alcohol ( HR 1.7 ; 95%CI , 1.2 to 2.5 ) . Patients who used over 10 mg of diazepam equivalent , who had a score of 3 or more on the Lack of Compliance subscale , or who drank more than 2 units of alcohol daily failed to achieve long-term abstinence . Conclusions : Benzodiazepine dependence severity affects long-term taper outcome independent of treatment modality , benzodiazepine dosage , psychopathology , and personality characteristics . An identifiable subgroup needs referral to specialized care
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 .