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 .
Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life.
BACKGROUND Older adults are the main recipients of repeat prescriptions for benzodiazepine ( BZD ) hypnotics . BZDs can impair cognitive function and may not aid sleep when taken continuously for years . This study therefore aim ed to determine if withdrawing from BZDs leads to changes in patients ' cognitive function , quality of life , mood and sleep . METHOD One hundred and ninety-two long-term users of BZD hypnotics , aged > or = 65 years , were identified in 25 general practice s. One hundred and four who wished to withdraw were r and omly allocated to one of two groups under double-blind , placebo controlled conditions : group A 's BZD dose was tapered from week 1 of the trial ; group B were given their usual dose for 12 weeks and then it was tapered . An additional group ( C ) of 35 patients who did not wish to withdraw from BZDs participated as ' continuers ' . All patients were assessed at 0 , 12 and 24 weeks and 50 % were reassessed at 52 weeks . RESULTS Sixty per cent of patients had taken BZDs continuously for > 10 years ; 27 % for > 20 years . Of all patients beginning the trial , 80 % had successfully withdrawn 6 months later . There was little difference between groups A and B , but these groups differed from continuers ( C ) in that the performance of the withdrawers on several cognitive/psychomotor tasks showed relative improvements at 24 or 52 weeks . Withdrawers and continuers did not differ in sleep or BZD withdrawal symptoms . CONCLUSIONS These results have clear implication s for clinical practice . Withdrawal from BZDs produces some subtle cognitive advantages for older people , yet little in the way of withdrawal symptoms or emergent sleep difficulties . These findings also suggest that , taken long-term , BZDs do not aid sleep
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 .