The Sleeping Pill Paradox: Better Sleep After Benzodiazepine Discontinuation
Putois Putois, Marie-Paule Gustin, Flore Collong, Mélinée Chapoutot, Hélène Bastuji, Wendy Leslie, Royce Anders, M. Havy
Medical Research Archives 2025 DOI: 10.18103/mra.v14i3.7329 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational cohort study with repeated measures Peer reviewed |
|---|---|
| Sample size | 107 |
| Population | Chronic benzodiazepine users enrolled in a withdrawal program |
| Intervention | Cognitive Behavioral Therapy for Insomnia (CBT-I) |
| Duration | 12 months, with assessments at baseline (T0), 3 months (T1), and 12 months (T2) |
| Measures | Insomnia Severity Index (ISI), Epworth Sleepiness Scale, Pichot Fatigue Scale, sleep quality (SQ), sleep efficiency (SE), sleep diary, non-standardized questions on dream and nightmare frequency (NFQ) |
| Key findings | Most participants stopped benzodiazepines completely or reduced use by more than 50%, and nearly all sleep and dream measures improved at 3 and 12 months except daytime sleepiness; chronic nightmares also decreased. The authors attribute these improvements mainly to benzodiazepine discontinuation rather than to cognitive behavioral therapy for insomnia techniques, and argue that gradual tapering benefits insomnia and dream activity. |
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.