Benzodiazepines and Sleep Architecture: A Systematic Review

Abstract

Background: Insomnia, defined as a difficulty in initiating or maintaining sleep, is a relevant medical issue. Benzodiazepines (BZDs) are commonly prescribed to treat insomnia. Two phases characterize human sleep structure: sleep with Non-Rapid Eye Movement (NREM) and sleep with Rapid Eye Movement (REM). Physiological sleep includes NREM and REM phases in a continuous cycle known as “Sleep Architecture.” Objective: This systematic review summarizes the studies that investigated BZDs changes on Sleep Architecture. Methods: The article’s selection included human clinical trials (in English, Portuguese, or Spanish) only, specifically focused on BZDs effects on sleep architecture. PubMed, BVS, and GoogleScholar databases were searched. Results: Findings on BZDs effects on sleep architecture confirm an increase in stage 2 of NREM sleep and a decrease in time of stages 3 and 4 of NREM sleep with a reduction in time of REM sleep during the nocturnal sleep. Conclusion: Variations in NREM and REM sleep may lead to deficits in concentration and working memory, and weight gain. The increase in stage 2 of NREM sleep may lead to a subjective improvement of sleep quality with no awakenings. BZDz should be prescribed with zeal and professional judgment. These patients should be closely monitored for possible long-term side effects.

Distinct Sleep Alterations in Alcohol Use Disorder Patients with and without Korsakoff’s Syndrome: Relationship with Episodic Memory

“…We found that KS patients still presented a lower proportion of REM sleep than AUD patients but did not differ any more from controls. This finding is in accordance with the literature [ 65 ], which indicates a reduction in time spent in REM sleep associated with the use of benzodiazepines. However, most KS patients receive psychotropic medications in their usual living conditions, which implies that the present findings reflect the clinical reality of KS patients [ 66 , 67 ].…”

Keep Your Mask On: The Benefits of Masking for Behavior and the Contributions of Aging and Disease on Dysfunctional Masking Pathways

“…Benzodiazepines have acute sedative and anxiolytic effects ( Konopka and Zimmerman, 2014 ). Taken acutely or chronically, these agents also impact the expression of the homeostatic sleep system, altering sleep architecture ( Holbrook et al, 2001 ; Ribeiro de Mendonça et al, 2021 ). Within the circadian system, benzodiazepines can produce major shifts in the endogenous rhythm ( Turek and Van Reeth, 1988 ) and can also impact entrainment to light ( Van Reeth and Turek, 1987 ).…”

Actigraphy monitoring in anxiety disorders: A mini-review of the literature

“…We were unable to obtain detailed data on the studies that pooled depressive and anxiety disorders. Furthermore, only two of the selected studies ( 20 , 21 ) took into account the potential interaction of benzodiazepine and/or antidepressant medication in the relationship between sleep and anxiety, despite their wide prescription in anxiety disorders (and particularly among anxious patients presenting sleep disorders) and the well-documented effects of these drugs on sleep architecture ( 35 , 36 ).…”