Long-term use of benzodiazepines in chronic insomnia: a European perspective

Abstract

Chronic insomnia occurs in ~10% of the general population and has numerous negative health effects. The recommended first line treatment of cognitive behavior therapy for insomnia is not widely available for patients in Europe, so pharmacotherapies such as benzodiazepine receptor agonist agents (benzodiazepines and Z-drugs) are commonly used. However, their use is only recommended for ≤4 weeks due to unproven long-term efficacy in treatment of chronic insomnia, and the risk of tolerance, and the potential for dependence and misuse. In Europe, recommendations limiting the use of benzodiazepines (lowest dose and shortest duration) in chronic insomnia are not always followed, likely due to the lack of approved effective alternative therapies. Here we present a recent pilot survey of the pharmacological treatment landscape in chronic insomnia in five European countries (France, Germany, Italy, Spain, and the United Kingdom) and physicians’ attitude toward treatment. The results suggest that benzodiazepines and Z-drugs are the most widely used treatments in chronic insomnia and are being used for longer than their recommended duration. Country variations in prescription rates were observed. Due to the known association between long-term benzodiazepine use and potential for developing dependence, further analysis of the literature was performed on the use and misuse of benzodiazepines. The results show that long-term use of benzodiazepines is associated with multiple consequences of treatment, including dependence, but also that previous use of benzodiazepines may increase the risk of opioid use disorder.

Psychopharmacoepidemiological trends in the Portuguese territory during the pandemic and post-pandemic periods (2019–2022)

“…While diazepam continues to play a role far beyond psychiatry, justifying its use, alprazolam, lorazepam and mexazolam together gather for their well-known use in panic attacks, insomnia and generalised anxiety disorder [2, 32]. The increase in the consumption of mexazolam since 2016 appears to be due to changing prescribing habits among healthcare professionals, particularly its very long half-life and safety [9].…”

Impact of a Novel Valerian Extract on Sleep Quality, Relaxation, and GABA/Serotonin Receptor Activity in a Murine Model

“…While benzodiazepines are beneficial for insomnia, the clinical benefit is minimal (less than 1 h of additional sleep) and comparable to that of exercise therapy alone [ 6 ]. Additionally, the long-term use of benzodiazepines for sleep can lead to adverse effects such as cognitive decline and a higher likelihood of motor vehicle accidents, falls, and fractures [ 7 ].…”

Assessment and management of chronic insomnia disorder: an algorithm for primary care physicians

“…Z-drugs is a term encompassing zopiclone, eszopiclone, zaleplon and zolpidem which are all approved for insomnia [13]. These medications are often used by PCPs beyond the ≤ 4-week recommendation, and their long-term use carries risks for patients in the form of tolerance, dependence, and misuse [14].…”