Sleep aid usage following benzodiazepine receptor agonist tapering and cognitive behavioral therapy for insomnia in middle-aged and older adults.

purposeTo describe temporal patterns of use of sleep aids (benzodiazepine receptor agonists [BZRAs], non-BZRAs [e.g., melatonin]) from baseline to 6FU associated with cognitive behavioral therapy for insomnia (CBTI) combined with BZRA tapering and to assess the odds of BZRA use at 6FU associated with non-BZRA use at baseline.

methodsUsing diary data from a trial comparing CBTI combined with a masked BZRA taper method (MTcap) versus standard open BZRA taper (SGT), we determined the frequency of four temporal patterns of sleep aid use at 6FU relative to baseline: 1) "less BZRA-nonBZRA", 2) "stable use BZRA-nonBZRA", 3) "more BZRA-nonBZRA", and 4) "less BZRA/more nonBZRA." We also assessed the use of specific non-BZAs (e.g., melatonin) and whether non-BZRA use at baseline predicted patterns of sleep aid use at 6FU.

resultsOf 139 participants (71 MTcap; 68 SGT), 63% used "less" (68% MTcap, 59% SGT), 26% were "stable use" (20% MTcap, 32% SGT), 5% used "more" (6% MTcap, 4% SGT), and 6% used "less BZRA but more nonBZRA" (7% MTcap, 4% SGT) at 6FU. Combination BZRA-nonBZRA was associated with increased odds of only nonBZRA use (OR = 9.05) and decreased odds of only BZRA (OR = .23) or no BZRA/nonBZRA (OR = .38) at 6FU compared to BZRA only at baseline.

conclusionsThe MTcap and SGT programs, both incorporating CBTI, were associated with less use of sleep aids at 6FU. BZRA deprescribing initiatives that include CBTI are effective in lowering sleep aid use among middle-aged and older adults. TRIALS REGISTRATION: Clinicaltrials.gov NCT03687086 Registered 9/27/2018. CURRENT KNOWLEDGE/STUDY RATIONALE: Protocols and clinical tapering guidelines are available to help patients taper off benzodiazepines and z-drugs used for insomnia. These protocols may be combined with cognitive behavioral therapy for insomnia to address underlying factors that perpetuate insomnia symptoms. However, discontinuing these medications may leave patients feeling like they need to turn to other medications or supplements to help them sleep. There is a paucity of empirical evidence on the types of sleep aids patients take after benzodiazepine and z-drug tapering, and whether cognitive behavioral therapy for insomnia in combination with benzodiazepine/z-drug tapering protocols is associated with discontinuation of other sleep aids. STUDY IMPACT: This analysis of data from a randomized trial found less sleep aid use 6 months after cognitive behavioral therapy for insomnia in combination with a benzodiazepine/z-drug tapering program. Only 6% of participants used more (i.e., increased) sleep aids that were not benzodiazepine/z-drugs at 6 months follow up.