Why Older People Shouldn't Take Xanax or Other Benzodiazepines for Insomnia

Sleep aids have become increasingly popular in Beijing, China, despite the potential for negative effects in older adults. Benzodiazepine receptor agonists (BZRAs), a class of medication used to treat insomnia and anxiety, are a particular concern due to their risk of dependency.

Researchers analyzed data from over 550,000 adult outpatient visits for insomnia at primary healthcare facilities in Beijing between 2016 and 2020. They found that the rate of prescriptions for BZRAs increased from 34.8% to 62.8% over the study period. Of particular concern is that the use of these medications also increased in older adults, despite guidelines advising against their routine use in this age group.

In contrast, the use of prescription sleep medications in the United States has been decreasing, according to a study of over 29,000 participants in the National Health and Nutrition Examination Survey from 2013 to 2018. The study found that the use of prescription sleep medications decreased by 31%, particularly over medium- and long-term durations, with an 86% decline seen among people 80 years or older. Efforts to reduce the prescribing of sleep medications to older adults, as well as an increase in behavioral treatments for sleep disturbances, are thought to have contributed to the decline. However, these trends occurred before the COVID-19 pandemic, which has disrupted sleep for many people around the world.

Although prescription sleep medications can have negative side effects, they can still be recommended by doctors in certain situations. Patients who have sleep disturbances due to shift work, chronic pain, or other medical conditions may benefit from sleep aids in addition to cognitive behavioral therapy for insomnia (CBT-i). Dr. Karin Johnson, a sleep medicine expert, notes that for some patients, CBT-i alone may not be sufficient, and medication may be necessary.

Insomnia is often accompanied by other disorders that can exacerbate symptoms, according to Dr. Ronald Gavidia Romero, another sleep medicine specialist. He recommends treating these issues to ensure the best outcome with CBT-i, sleep aids, or a combination of both. Sleep aids can also be helpful for those who need assistance sleeping for a few days, such as after the death of a loved one. However, it's important to note that certain patients, such as older adults, and those with a history of sleepwalking or drug use, may not be suitable candidates for sleep aids.

CBT-i is the preferred initial approach for chronic insomnia, according to Gavidia Romero. It has the advantage of not exposing patients to the potential side effects of medications. Sleep hygiene, including creating a conducive sleep environment, avoiding caffeine and nicotine before bed, and establishing a regular sleep schedule, is a key aspect of CBT-i. Additionally, the cognitive part of this therapy addresses negative sleep thoughts, which can contribute to difficulty sleeping. Overall, sleep aids may be appropriate for some patients, but CBT-i is a preferred option for chronic insomnia.

References:

Radcliffe, S., Gifford, M., Kaufmann, C., Dasgupta, R., & Kiefer, A. (2023, February 21). Why Older People Shouldn't Take Benzodiazepines for Insomnia. Healthline. Retrieved February 21, 2023, from https://www.healthline.com/health-news/why-older-people-shouldnt-take-xanax-or-other-benzodiazepines-for-insomnia#Cognitive-behavioral-therapy-for-insomnia