Benzodiazepines, a drug commonly prescribed in Quebec for anxiety and insomnia, do not improve sleep quality in older adults in the long term.
On the contrary, seniors’ sleep deteriorates and the risk of falls increases, according to a recent study led by researchers at Concordia University.
Among the best-known brands of drugs belonging to the benzodiazepine class are Valium, Xanax and Ativan.
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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 to 80.
To arrive at these findings, researchers Thanh Dang-Vu and Loïc Barbaux studied 101 older adults divided into three groups: good sleepers, people with insomnia, and people with insomnia who were chronic users of benzodiazepines or BZRAs (consuming them at least three times a week for more than three months).
For the general adult population, “there isn’t really a red flag,” says Loïc Barbaux, lead author of the study and PhD candidate in the Department of Health, Kinesiology and Applied Physiology at Concordia University. Young adults can safely take these drugs to treat anxiety and insomnia, but only for short periods of time.
“However, once you pass the age of 65, the American Geriatrics Society strongly advises against their use, whether short-term or long-term, specifically because of the increased adverse effects associated with their use. There are no such restrictions for adults, but we still know that their use can be dangerous. It all depends on the duration and dose of consumption,” said Barbaux.
The study, published in the medical journal Sleep, also points to the addictive effect of these drugs. They can cause withdrawal symptoms if patients stop taking them abruptly.
“These include tremors and an increased risk of falling, which is why we consider that in older populations, this can be very dangerous given the consequences of a hip fracture, for example, in this population,” said Barbaux.
Fortunately, health-care professionals seem to be less inclined to prescribe them, according to data from the Institut national de santé publique du Québec (INSPQ).
Between 2012 and 2022, the proportion of people aged 65 and over using potentially inappropriate medications decreased statistically significantly in Quebec, from 49 to 45 per cent. This decrease is mainly due to the decline in the prevalence of benzodiazepine use, which fell from 28.4 to 16.7 per cent.
“People who use benzodiazepines report a subjective increase in sleep quality in the short term,” says Barbaux. “We looked at the objective aspect of sleep quality, the actual structure of sleep itself. It’s always important to distinguish between the subjective aspect of sleep, what patients report, and their objective sleep quality.”
The sleep of the study participants was monitored using overnight polysomnography, which measures overall sleep structure, brain wave activity and significant oscillations.
“Then we realized that there is a real difference. Unfortunately, it doesn’t have the effects we would like. We would like it to improve sleep quality. In reality, we are seeing a deterioration in certain parameters that are important, particularly for memory and cognitive health,” explained Barbaux.
The results show no difference in REM sleep.
“It’s as if taking these drugs does not affect the duration of this particular stage of sleep,” the researcher said. “On the other hand, we measured a sharp decrease in deep sleep, which generally occurs in the first part of the night. We really saw a reduction in this stage of sleep, which is linked to memory consolidation.”
There are alternatives to benzodiazepines, such as cognitive behavioural therapy.
“This intervention, combined with drug withdrawal, has been shown to restore sleep quality,” said Barbaux.
According to him, much research remains to be done to understand how to restore sleep quality in the elderly population, which is particularly affected by symptoms of insomnia.
“The real challenge,” he says, “will be to find a specific intervention in this population that addresses both the subjective and objective components of sleep.”
–This report by La Presse Canadienne was translated by CityNews
