Chronic Use of Benzodiazepine Sleeping Pills Disrupts Sleep In Older Adults

By Dr. Gregg D. Jacobs

Despite the fact that newer, safer non-benzodiazepine sleeping pills have been developed for insomnia (e.g., Ambien, Sonata), the traditional benzodiazepines (Klonopin, Ativan, Xanax, Restoril, Dalmane, etc) are still the most widely prescribed medications for insomnia.

Most patients who are prescribed benzodiazepines, particularly older adults, continue to use them for prolonged periods. This recent study published in the journal Sleep by Dr. C.H. Bastien and her colleagues at the Laval University in Canada examined the effects of regular use of benzodiazepine sleeping pills in older adults on sleep EEG parameters.

The researchers measured the sleep architecture of three groups of older adults in the sleep lab: good sleepers, insomniacs who were drug-free, and insomniacs who used benzodiazepines regularly (at least 3 nights per week for at least 3 months).

They found that, relative to good sleepers, the benzodiazepine users spent more time in light sleep (stage 2) and less time in deep sleep (stages 3 and 4). Compared to unmedicated insomniacs and good sleepers, the benzodiazepines users also exhibited more micro arousals (brief awakenings) during the night. The researchers also used power spectral analysis of EEG activity to examine the amount of power in various EEG frequency bands (such as delta EEG) across the night.

They found that benzodiazepine users had less delta and theta EEG power and increased beta EEG power than non-drug insomniacs and good sleepers. Because delta EEG is the EEG frequency that characterizes deep sleep while beta EEG is associated with arousal, these findings suggest that the benzodiazepine users exhibited sleep patterns that were characterized by more arousal and less sound, deep sleep.

Overall, the findings of this study suggest that benzodiazepines do not normalize sleep in older insomniacs who use these medications regularly. Instead, these medications are associated with disrupted sleep architecture as evidenced by increased light stages of sleep and decreased deep sleep (deep sleep is considered the most important stage of sleep due to its restorative and recuperative effects) and that these adverse effects on sleep architecture do not habituate over time.