‘In addition to not being very safe, these drugs also make sleep quality worse in ways that may be detrimental to brain health.’
Key takeaways:
- Long-term use of benzodiazepines and benzodiazepine receptor agonists (BZRA) in older adults worsens sleep quality by reducing deep sleep stages and disrupting brain oscillation coupling needed for memory consolidation.
- Higher dosages were associated with longer sleep latency and delays in reaching deep sleep.
- Chronic users (≥3 times per week for >3 months) experienced poorer overall sleep architecture compared to those with insomnia who were not taking the drugs.
Cheap and widely available, benzodiazepines and related drugs are commonly prescribed to treat insomnia. But a new study led by Concordia researchers shows that use of benzodiazepines and benzodiazepine receptor agonists (BZRA) can affect brain rhythms during sleep that are important for memory and cognitive health in adults aged between 55 and 80.
“These drugs don’t even improve the sleep of the older adults using them on the long-term,” says study co-author Thanh Dang-Vu, MD, PhD, FAASM (left in the photo), a neurologist at the Institut universitaire de gériatrie de Montréal.
“In addition to not being very safe, these drugs also make sleep quality worse in ways that may be detrimental to brain health.”
Disrupted Dleep Architecture
The researchers studied 101 older adults categorized into three groups: good sleepers, individuals with insomnia, and individuals with insomnia who chronically use benzodiazepines/BZRAs, defined as using them a minimum of three times per week for more than three months.
Participants’ sleep was measured using an overnight polysomnography.
“Compared to the insomnia group, the group using these sleeping pills had a lower amount of deep sleep stages,” says Loïc Barbaux, PhD, the study’s lead author, in a release. “These deep sleep stages, which are characterized by slower brain waves, heart rate, and breathing, are very important for memory consolidation.”
They also observed a decrease in the coupling between brain oscillations among individuals using benzodiazepines/BZRAs. This is a neural process in which brain rhythms synchronize with each other and facilitate information processing, including memory consolidation.
Dosage also played a role. Users with higher dosages needed more time to fall asleep and took longer to reach deep sleep.
“These findings have led us to conclude that taking these kinds of sleeping pills worsens overall sleep architecture and brain oscillation activities,” says Barbaux. “This may explain previous reports that these pills can impair some cognitive functions, which are already in decline due to aging.”
Accessible Alternatives Needed
Dang-Vu, who is also a professor in the Department of Health, Kinesiology and Applied Physiology where he leads the Sleep, Cognition and Neuroimaging Laboratory, says benzodiazepines and BZRAs may be safely and effectively used to treat anxiety and insomnia in younger adults, but mainly for short time frames. He agrees with organizations, including the American Geriatrics Society, that recommend benzodiazepines be avoided entirely by adults over age 65.
For older adults who are chronic users, he recommends a gradual decrease of benzodiazepine consumption over several months, coupled with a cognitive behavioral therapy for insomnia program. (Quitting these drugs cold turkey can lead to withdrawal symptoms, including increased risk of falls, hospitalization, and cognitive issues.)
“If we reduce consumption progressively, we can avoid what we call rebound insomnia, which is a return of insomnia symptoms but at more intense levels. A psychological intervention can help achieve a successful withdrawal from these drugs and improve sleep quality,” says Dang-Vu.
