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Chronic Use of Benzodiazepines for Insomnia

Abstract: Why do 10% of all patients with chronic insomnia stay on benzodiazepines?

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Chronic Use of Benzodiazepines for Insomnia

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Question(s): 
Written by: Martin Winkler
First version: 22 Jul 2008.
Latest revision: 27 Aug 2008.

What are the effects of chronic use of benzodiazepines for insomnia?

Answer:

Despite the fact that all clinical guidelines and recommendations restrict a therapeutic use of the different types of sleeping pills to a limited period (not longer than 4-6 weeks) we know that at least 10% of all patients with chronic insomnia use benzodiazepine regularly for more than a year.

There is no clear evidence of a therapeutic use longer than 4 weeks and only very little knowledge about possible long-term effects of benzodiazepine medication/abuse for this group of patients. There is a significant risk of tolerance and addiction. But despite this fact we have a group of patients insisting on an extended prescription of these pills because they claim a (subjective) positive effect without raising the dose. Very often these patients will, if necessary, consult other doctors or use illegal ways to get their benzodiazepines.

Patients with chronic insomnia very often have additional characteristics causing an additional risk with this treatment option:

  • Elderly patients.
  • Oher psychiatric disorders (anxiety, personality disorders, bipolar disorders, schizophrenia).
  • Risk population (prone to other addictions).
  • Known tolerance effects to other sleeping pills.

Patients and therapists should avoid using sleeping pills for an extended period without introducing appropriate treatment approaches for insomnia (sleep hygiene, cognitive-behavioural therapy, relaxation therapies).

Any extended use of benzodiazepines should be restricted to clear indications after extensive evaluation by a skilled psychiatrist.

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