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 .
Insomnia in young men and subsequent depression. The Johns Hopkins Precursors Study.
The Johns Hopkins Precursors Study , a long-term prospect i ve study , was used to study the relation between self-reported sleep disturbances  and subsequent clinical depression and psychiatric distress .  A total of 1,053 men provided information on sleep habits during medical school at The Johns Hopkins University ( classes of 1948 - 1964 ) and have been followed since graduation . During a median follow-up period of 34 years ( range 1 - 45 ) , 101 men developed clinical depression  ( cumulative incidence at 40 years , 12.2 % ) , including 13 suicides . In Cox proportional hazards analysis adjusted for age at graduation , class year , parental history of clinical depression , coffee drinking , and measures of temperament , the relative risk of clinical depression was greater in those who reported insomnia in medical school ( relative risk ( RR ) 2.0 , 95 % confidence interval ( CI ) 1.2 - 3.3 ) compared with those who did not and greater in those with difficulty sleeping under stress in medical school ( RR 1.8 , 95 % CI 1.2 - 2.7 ) compared with those who did not report difficulty . There were weaker associations for those who reported poor quality of sleep ( RR 1.6 , 95 % CI 0.9 - 2.9 ) and sleep duration of 7 hours or less ( RR 1.5 , 95 % CI 0.9 - 2.3 ) with development of clinical depression . Similar associations were observed between reports of sleep disturbances in medical school and psychiatric distress assessed in 1988 by the General Health Question naire . These findings suggest that insomnia in young men is indicative of a greater risk for subsequent clinical depression and psychiatric distress that persists for at least 30 years
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 .