Benzodiazepines disrupt sleep in seniors

Commonly prescribed for anxiety and insomnia, benzodiazepines are not at all beneficial in the long term for the sleep quality of older adults. On the contrary, sleep deteriorates in seniors, and the risk of falls increases, according to a recent study led by researchers at Concordia University in Montreal.Among the best-known brands of medications belonging to the benzodiazepine class are Valium, Xanax and Ativan.The use of benzodiazepines and benzodiazepine receptor agonists (BZRAs) can affect brain rhythms during sleep, which plays an important role in memory consolidation and cognitive health in adults aged 55 and older.To arrive at these results, Dr. Thanh Dang-Vu and Loïc Barbaux studied 101 elderly individuals divided into three groups: good sleepers, those suffering from insomnia, and those suffering from insomnia and chronically using benzodiazepines or BZRAs (taking them at least three times a week for more than three months).For the general adult population, "There isn't really a red flag," said Barbaux in an interview, lead author of the study and a doctoral candidate in the department of health, kinesiology and applied physiology at Concordia. Young adults can safely take these medications to treat anxiety and insomnia, but primarily for short periods.“Once you pass the age of 65, the American Geriatric Association absolutely does not recommend their consumption, whether in the short or long term, specifically because of the increased adverse effects associated with their use. For adults, there are no such restrictions, but we still know that their use can be dangerous. It all depends on the duration and dose of their consumption,” explained Barbaux.The study, published in the medical journal Sleep, also highlights the addictive effect of these medications. They can cause withdrawal symptoms if patients stop taking them abruptly. These can include, for example, tremors and their use or misuse can result in increased risk of falls, which is why they are considered to be dangerous in older populations, given the potential consequences of a hip fracture in this population noted Barbaux.Fortunately, healthcare professionals appear to be less inclined to prescribe them, according to data from the Quebec National Institute of Public Health. Between 2012 and 2022, the proportion of people aged 65 and over who are using potentially inappropriate medications decreased significantly in Quebec, from 49% to 45%. This decrease is mainly due to a decline in the prevalence of benzodiazepine use, which fell from 28.4% to 16.7%.Restoring sleep quality graduallyPeople taking benzodiazepines report a short-term subjective improvement in sleep quality, said Barbaux. “We were looking at the objective aspect of sleep quality, really the structure of sleep itself,” he said. “It’s always important to distinguish the subjective aspect of sleep, what patients report, and contrast it with their objective sleep quality.”The study participants’ sleep was observed using overnight polysomnography, which measures the overall structure of sleep, brain-wave activity and significant oscillations.“Then we realized there was a real difference. Unfortunately, the medications don't have the effects we wanted. We wanted it to improve sleep quality, but it leads to a decline in certain important parameters, particularly for memory and cognitive health,” said Barbaux.Decrease in deep sleepThe results showed no difference in REM sleep. "It's as if taking these medications doesn't affect the duration of this particular sleep stage. However, we measured a significant decrease in deep sleep, which is generally present in the first part of the night. We really observed a reduction in this sleep stage, which is linked to memory consolidation."To replace benzodiazepines, there are alternatives, such as cognitive behavioural therapy. "This intervention, combined with medication withdrawal, has shown a restoration of sleep quality," Barbaux noted.There is still much research to be done to understand how to restore the quality of sleep in the elderly population, which is particularly affected by symptoms of insomnia disorders.“The real challenge,” he said, “will be finding a specific intervention for this population that addresses both the subjective and objective components of sleep.”

Benzodiazepines disrupt sleep in seniors

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