Chronic Sedative-Hypnotic Use Linked to Poorer Sleep in Older Adults With Insomnia

Chronic benzodiazepines (BZDs) or benzodiazepine receptor agonists (BZRAs) use is associated with poorer sleep quality and disrupted brain oscillatory activity in older adults with insomnia, according to findings published in Sleep.

Although BZDs and BZRAs are frequently prescribed for insomnia in older populations, their long-term use may compromise sleep quality and cognitive health. This study evaluated the effects of chronic sedative-hypnotic use on both sleep macro- and micro-architecture, including brain oscillations critical for memory consolidation.

A cross-sectional analysis was conducted using polysomnographic data from 101 older adults aged 55 to 80 years (mean [SD] age, 66.05 [5.84]; 73% women). Participants were classified as good sleepers (GS; n=28), those with insomnia not using sleep medications (INS; n=26), and those with insomnia who reported chronic BZD/BZRA use (MED; n=47). The MED group included individuals taking diazepam-equivalent doses of 6.1 (SD, 3.8) mg for over 3 nights per week, for more than 3 months. Participants taking BZD and BZRA for non-sleep related purposes only were excluded. In the INS and GS groups, participants using any sleep-inducing medication or receiving and sleep-related interventions were excluded.

Compared with the GS group, both insomnia cohorts exhibited lower sleep efficiency (P <.01). However, the MED group showed additional disturbances in sleep architecture, including increased time spent in light sleep (N1) and reduced time in deep sleep (N3) (all Q<.001). No significant differences were observed in rapid eye movement (REM) duration, although REM latency was prolonged among MED participants.

Spectral EEG analyses revealed lower relative theta power in both non-REM (NREM) and REM sleep in the MED group compared with the GS and INS groups (all Q<.04). Additionally, MED participants displayed higher frontal sigma power during NREM sleep (Q=.03) and a reduced delta/beta ratio (Q=.02), indicating elevated cortical arousal.

Spindle characteristics also differed across groups. Frontal spindle density was significantly higher in the MED group vs INS (Q=.02), while slow oscillation characteristics remained largely unchanged. MED participants showed weaker coupling strength between slow oscillations and spindles and delayed phase-amplitude coupling compared with GS participants (Q=.03), suggesting impaired coordination of memory-relevant brain rhythms.

Exploratory analysis within the MED group revealed dose-dependent disruptions. Higher BZD/BZRA doses were correlated with increased latency to deeper sleep stages and elevated high-frequency spectral activity (Q<.01). No significant differences were observed between BZD and BZRA subgroups after adjusting for dosage.

Study limitations include the retrospective cross-sectional design, limited sample size, reliance on self-reported BZD/BZRA use, and underrepresentation of male participants.

“The current findings highlight the impact of chronic use of sedative-hypnotics on sleep and suggest these may have detrimental health outcomes, including for cognitive decline,” the study authors concluded.

Disclosures: This research was supported by the Canadian Institutes of Health Research. Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.