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 .
Withdrawal reaction after long-term therapeutic use of benzodiazepines.
We conducted a double-blind , placebo-controlled trail in which 40 patients who had undergone long-term therapy with benzodiazepines  were switched to placebo or to diazepam in a dose approximately equivalent to their usual dose of the benzodiazepine ; the dose of diazepam was then tapered during an eight-week period . Patients were assessed clinical ly and psychologically and had weekly sessions of behavioral therapy . The subjects who received placebo had more symptoms , assessed their symptoms as more severe , and stopped taking the study drug at a higher rate than those receiving the tapering doses of diazepam . The subjects in the placebo group also had symptoms shortly after being switched to placebo , whereas those in the diazepam group had symptoms much later . Some withdrawal symptoms were distinct from those of anxiety ( e.g. , tinnitus , involuntary movement , and perceptual changes ) . Withdrawal symptoms occurred earlier in patients who had received short-acting benzodiazepines than in those who had received long-acting benzodiazepines . Symptoms gradually disappeared over a four-week period in both the placebo and the diazepam groups . Serial determination of plasma benzodiazepine concentrations was a useful way to assess compliance , treatment outcome , and relapse during withdrawal . We conclude that a clinical ly important , mild , but distinct withdrawal syndrome occurs after discontinuation of long-term therapeutic use of benzodiazepines
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 .