Abstract
Objectives
Chronic use of benzodiazepines and z-drugs (BZD/Zs), the most commonly used symptomatic treatment for sleep problems, is discouraged because of the unproven long-term effectiveness. In this study, we evaluated 1-year evolution of subjective sleep quality of chronic BZD/Z users compared with nonusers.
Methods
All cognitively competent residents from ten Belgian nursing homes were screened and compiled in a group of chronic BZD/Z users or nonusers, based on the medication chart. We collected demographic, functional and psychometric characteristics (depressive symptoms with the 8-item Geriatric Depression Scale), sleep parameters (with the Pittsburgh Sleep Quality Index—PSQI) and medication use. We analysed evolution of sleep quality with nonparametric statistics. Associations with worsening of sleep quality were analysed with linear regression.
Results
We collected data of 131 BZD/Z users and 95 nonusers. The mean age in both groups was 85 years and 77 % was female. Over a period of 1 year, the PSQI score evolved from 5.2 to 5.8 (p = 0.035) in the BZD/Z users, and from 4.3 to 4.7 (p = 0.078) in the nonusers. Though the mean deterioration in 1 year did not differ significantly between both groups, the BZD/Z users had a significantly worse sleep quality compared with nonusers at both time points. Depressive symptoms were significantly associated with worsening sleep quality (β = −0.243, p < 0.001).
Conclusion
Sleep quality in chronic BZD/Z users significantly decreased over 1 year and was significantly worse than in nonusers at the end of this period. This study suggests that using BZD/Zs chronically does not maintain or improve sleep quality. Depressive symptoms are an important factor in the deterioration of sleep quality.
References
Conn DK, Madan R. Use of sleep-promoting medications in nursing home residents: risks versus benefits. Drugs Aging. 2006;23(4):271–87.
Bourgeois J, Elseviers MM, Azermai M, Van Bortel L, Petrovic M, Vander Stichele RR. Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages. Eur J Clin Pharmacol. 2012;68(5):833–44.
Holbrook AM, Crowther R, Lotter A, Cheng C, King D. Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ. 2000;162(2):225–33.
Mets MA, Volkerts ER, Olivier B, Verster JC. Effect of hypnotic drugs on body balance and standing steadiness. Sleep Med Rev. 2010;14(4):259–67.
Vinkers CH, Olivier B. Mechanisms underlying tolerance after long-term benzodiazepine use: a future for subtype-selective GABA(A) receptor modulators? Adv Pharmacol Sci. 2012;2012:416864.
Poyares D, Guilleminault C, Ohayon MM, Tufik S. Chronic benzodiazepine usage and withdrawal in insomnia patients. J Psychiatr Res. 2004;38(3):327–34.
Krystal AD, Erman M, Zammit GK, Soubrane C, Roth T. Long-term efficacy and safety of zolpidem extended-release 12.5 mg, administered 3–7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Sleep. 2008;31(1):79–90.
Ohayon MM, Caulet M, Arbus L, Billard M, Coquerel A, Guieu JD, et al. Are prescribed medications effective in the treatment of insomnia complaints? J Psychosom Res. 1999;47(4):359–68.
Englert S, Linden M. Differences in self-reported sleep complaints in elderly persons living in the community who do or do not take sleep medication. J Clin Psychiatry. 1998;59(3):137–44 (quiz 45).
Beland SG, Preville M, Dubois MF, Lorrain D, Grenier S, Voyer P, et al. Benzodiazepine use and quality of sleep in the community-dwelling elderly population. Aging Mental Health. 2010;14(7):843–50.
Bourgeois J, Elseviers MM, Van Bortel L, Petrovic M, Vander Stichele RH. Sleep quality of benzodiazepine users in nursing homes: a comparative study with nonusers. Sleep Med. 2013;14(7):614–21.
Beland SG, Preville M, Dubois MF, Lorrain D, Voyer P, Bosse C, et al. The association between length of benzodiazepine use and sleep quality in older population. Int J Geriatr Psychiatry. 2011;26(9):908–15.
Monane M, Glynn RJ, Avorn J. The impact of sedative-hypnotic use on sleep symptoms in elderly nursing home residents. Clin Pharmacol Ther. 1996;59(1):83–92.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.
Alencar MA, Dias JM, Figueiredo LC, Dias RC. Frailty and cognitive impairment among community-dwelling elderly. Arquivos Neuropsiquiatr. 2013;71(6):362–7.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.
Sasai T, Inoue Y, Komada Y, Nomura T, Matsuura M, Matsushima E. Effects of insomnia and sleep medication on health-related quality of life. Sleep Med. 2010;11(5):452–7.
Jongenelis K, Gerritsen DL, Pot AM, Beekman AT, Eisses AM, Kluiter H, et al. Construction and validation of a patient- and user-friendly nursing home version of the Geriatric Depression Scale. Int J Geriatr Psychiatry. 2007;22(9):837–42.
Dijk DJ, Groeger JA, Stanley N, Deacon S. Age-related reduction in daytime sleep propensity and nocturnal slow wave sleep. Sleep. 2010;33(2):211–23.
Hayashino Y, Yamazaki S, Takegami M, Nakayama T, Sokejima S, Fukuhara S. Association between number of comorbid conditions, depression, and sleep quality using the Pittsburgh Sleep Quality Index: results from a population-based survey. Sleep Med. 2010;11(4):366–71.
Komada Y, Nomura T, Kusumi M, Nakashima K, Okajima I, Sasai T, et al. Correlations among insomnia symptoms, sleep medication use and depressive symptoms. Psychiatry Clin Neurosci. 2011;65(1):20–9.
Benca RM, Peterson MJ. Insomnia and depression. Sleep Med. 2008;9(Suppl 1):S3–9.
Elseviers MM, Vander Stichele RR, Van Bortel L. Drug utilization in Belgian nursing homes: impact of residents’ and institutional characteristics. Pharmacoepidemiol Drug Saf. 2010;19(10):1041–8.
Curran HV, Collins R, Fletcher S, Chin YKS, Woods RT, Iliffe S. Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life. Psychol Med. 2003;33(7):1223–37.
Morin CM, Belanger L, Bastien C, Vallieres A. Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse. Behav Res Ther. 2005;43(1):1–14.
Bourgeois J. EM, Azermai M, Van Bortel L, Petrovic M, VanderStichele R. Barriers to discontinuation of chronic benzodiazepine use in nursing home residents: perceptions of general practitioners and nurses. Eur Geriatr Med. 2014;5(3):181–7.
Acknowledgments
We thank Anne Balis, Kim Elst, Jacqueline De Pooter and Ambre Hamelink, all Masters of Science in Nursing at the University of Antwerp, for their contribution in the data collection. We also thank the management and staff of the participating nursing homes.
No sources of funding were used to conduct this study. Jolyce Bourgeois, Monique M. Elseviers, Luc Van Bortel, Mirko Petrovic and Robert H. Vander Stichele have no conflicts of interest to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bourgeois, J., Elseviers, M.M., Van Bortel, L. et al. One-Year Evolution of Sleep Quality in Older Users of Benzodiazepines: A Longitudinal Cohort Study in Belgian Nursing Home Residents. Drugs Aging 31, 677–682 (2014). https://doi.org/10.1007/s40266-014-0203-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40266-014-0203-3