The Sleeping Pill Paradox: Better Sleep After Benzodiazepine Discontinuation

Abstract

Purpose of the study: The objective of this study is to evaluate subjective changes in sleep, insomnia, and dream production in chronic benzodiazepine (BZ) users enrolled in a withdrawal program. BZs, widely prescribed to treat insomnia, are likely to alter sleep structure. This research aims to determine the extent to which discontinuing these treatments promotes the restoration of sleep and dream processes.
Method: The study is based on data from a drug withdrawal program combined with Cognitive Behavioral Therapy for Insomnia (CBT-I), including 107 participants presenting prolonged use of BZs. Assessments were conducted at three time points: before the program (T0), after 3 months on the program (T1), and after 12 months (T2). The main variables included the severity of insomnia (ISI), sleepiness (Epworth), fatigue (Pichot), sleep quality and efficiency (SQ and SE), sleep parameters (diary), and the frequency of dreams and nightmares (non-standardized questions; NFQ). The analyses were conducted using repeated measures ANOVAs and post hoc tests, with withdrawal status and sleep restriction practice as between-subject factors.
Results: The majority of participants managed to stop using BZs completely or reduce their consumption by more than 50%. Overall, all sleep and dream parameters showed improvement with BZs reduction or discontinuation, except for daytime sleepiness. The number of individuals experiencing chronic nightmares also decreased. Individuals who completely stopped using BZs showed a greater reduction in the severity of their insomnia. These improvements associated with BZs reduction were independent of continued use of CBT-I methods.
Conclusion: These results indicate that the observed benefits to sleep quality and wellness, including dream activity, found both in the medium and long term, were mainly attributed to BZs discontinuation, rather than to the application of behavioral techniques (which may hence serve rather to achieve said discontinuation). Discontinuing BZs, preferably through gradual tapering, therefore appears beneficial for improving insomnia and regulating dream activity.