The association between benzodiazepine use and sleep quality in residential aged care facilities: a cross-sectional study

Abstract

BackgroundBenzodiazepines are commonly prescribed in residential aged care facilities (RACFs) for their sedative and anxiolytic effects. The objective of this study was to investigate the association between benzodiazepine use and sleep quality in residents of RACFs.MethodsA cross-sectional study involving 383 participants was conducted in six Australian RACFs. Night-time sleep quality, day-time drowsiness and day-time napping behavior were assessed using a validated questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the association between benzodiazepine use and sleep quality. Covariates included pain, dementia severity, depression, insomnia and other sedative use.ResultsOf the 383 residents (mean age 87.5 years, 77.5% female), 96(25.1%) used a benzodiazepine on a regular basis. Residents who used long-acting benzodiazepines on a regular basis had higher night-time sleep quality than non-users (AOR = 4.00, 95%CI 1.06 – 15.15). Residents who used short-acting benzodiazepines on a PRN only basis had longer daytime napping times than non-users (AOR = 1.77, 95%CI 1.01 – 3.08). No benzodiazepine category was associated with day-time drowsiness.ConclusionsThe association between benzodiazepine use and sleep quality is dependent on the half-life and prescribing pattern of the benzodiazepine. Short-acting PRN benzodiazepines were associated with lower night time sleep quality and longer day-time napping compared to long-acting regular benzodiazepines. Longitudinal studies are needed to determine whether these findings reflect channeling of short-acting agents to residents at higher risk of sleep disorders.

The association between physical and mental chronic conditions and napping

“…Next, patients with depression and/or anxiety may be treated by sedative drugs, which may increase their ability to nap. In a group of institutionalized elderly individuals in Australia, the use of benzodiazepines was associated with longer daytime napping (OR = 1.77) 43 . Patients with depression may also feel that napping reduced the severity of their symptoms and thus improved their well-being.…”

Prescription Benzodiazepine Use Among Older Adults: A Critical Review

“…33 Several recent studies have shown that long term BZD use for insomnia is associated with worsening sleep quality, including difficult falling asleep and more nighttime awakenings, as compared to non-users. 34–37 Clinicians may consider use of non-benzodiazepine receptor agonist (“Z-drugs”) as a safer alternative, however, studies demonstrate a similar concerning side effect profile for use in older adults including increased risk of falls, 38 fracture, 39 impaired cognition, 31 and motor vehicle accidents 40 due to morning after impairment. In addition, a variety of newer studies have established that CBT is an effective treatment for insomnia, if not more effective than BZD and sedative hypnotics in a general adult population, 41,42 yet without any of the associated potential risks.…”

Impact of Sleep Disorder as a Risk Factor for Dementia in Men and Women

“…High doses of many short-acting benzodiazepines can also cause pre and post-mortem memory loss and dissociation. This property makes benzodiazepines useful for treating insomnia, anxiety, agitation, seizures, alcohol withdrawal, muscle spasms, and medication before medical or dental procedures (Chen et al ., 2016). Benzodiazepines are classified as having short-term, intermediary, or long-term behaviors.…”