Masked Tapering Boosts Benzodiazepine Discontinuation for Insomnia Patients: SLEEP 2025
SEATTLE, WA – A novel approach to benzodiazepine deprescribing, combining masked tapering with augmented cognitive behavioral therapy for insomnia (CBT-I), shows promising results in helping older adults discontinue long-term use of these medications. The findings, presented at SLEEP 2025, highlight the potential of this method to improve sleep quality and reduce reliance on benzodiazepines (BZRA) among individuals with insomnia.
The Masked Tapering Approach
researchers,led by Dr. Constance Fung from the David Geffen School of Medicine at UCLA,developed a Masked Taper plus cognitive behavioral therapy-augmented program (MTcap) to minimize placebo effects and boost discontinuation. The study involved 188 adults aged 55 and older (average age 69.2 years, 34.6% female) who had been using alprazolam, lorazepam, temazepam, or zolpidem for at least two nights per week for a minimum of three months. Participants used a BZRA an average of 5.9 days a week.
Did You Know? Benzodiazepines are associated with a 36% increased risk of dementia in older adults, according to a 2012 study in JAMA Internal medicine.
Study Results: MTcap vs. Standard Tapering
The multi-site trial compared eight weeks of MTcap with standard, gradual tapering. Six months after treatment, the MTcap group showed a significantly higher BZRA discontinuation rate (73.4%) compared to the standard tapering group (58.6%). Both groups experienced improvements in insomnia severity, as measured by the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index.
Specifically, baseline epworth Sleepiness Scale scores increased from 6.32 and 6.21 at baseline for MTcap and standard taper,respectively,to 3.98 and 3.92 at 1 week and 4.54 and 3.91at 6 months. Pittsburgh Sleep Quality index scores also showed improvements from baseline to week 1 and month 6 in both arms.
| Outcome | MTcap | Standard Tapering |
|---|---|---|
| BZRA discontinuation (6 months) | 73.4% | 58.6% |
| Average Age of Participants | 69.2 years | 69.2 years |
Challenging Thoughts About Medication
A key element of the masked tapering program involved a diary where participants recorded their perceived nightly dosage compared to their baseline dose. This approach encouraged patients to question the actual effectiveness of their medication.
Pro Tip: Gradual tapering, combined with behavioral therapies, is recommended by the American Academy of Family Physicians for safe benzodiazepine discontinuation.
Dr. Fung emphasized the importance of patients asking themselves, “Is this pill really doing something for me?” The goal is for patients to recognize that they may not be sleeping well and may not necessarily need a sleeping pill after completing the MTcap program.
Future Research Directions
Further analyses are planned to gain a better understanding of the factors contributing to the sustained discontinuation rates observed in the study. researchers aim to identify the specific mechanisms through which masked tapering and augmented CBT-I promote long-term success.
What strategies have you found most effective in managing insomnia without medication? How can healthcare providers better support patients in safely discontinuing benzodiazepines?
Benzodiazepines and Insomnia: An Evergreen Perspective
Benzodiazepines are a class of psychoactive drugs primarily used to treat anxiety, insomnia, and seizures. While effective for short-term relief, long-term use can lead to dependence, tolerance, and a range of adverse effects, particularly in older adults.Insomnia, characterized by difficulty falling or staying asleep, affects millions worldwide and can significantly impact quality of life. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a non-pharmacological treatment that addresses the underlying causes of insomnia through behavioral and cognitive techniques. Studies have shown that CBT-I is as effective as medication in the short term and more effective in the long term, without the risks associated with drug dependence and side effects. The increasing awareness of the risks associated with long-term benzodiazepine use has led to a growing emphasis on deprescribing strategies and alternative treatments like CBT-I.
Frequently Asked Questions About Benzodiazepine Discontinuation
- What are the risks of long-term benzodiazepine use?
- Long-term use can lead to dependence, tolerance, cognitive impairment, increased risk of falls, and paradoxical effects like increased anxiety or insomnia.
- What is Cognitive Behavioral Therapy for Insomnia (CBT-I)?
- CBT-I is a structured program that helps individuals identify and change thoughts and behaviors that contribute to insomnia. it includes techniques like sleep restriction, stimulus control, and relaxation training.
- How does masked tapering work?
- Masked tapering involves gradually reducing the dosage of a medication without the patient’s knowledge of the specific tapering schedule,minimizing potential placebo effects and psychological dependence.
- Is it safe to stop benzodiazepines abruptly?
- Abruptly stopping benzodiazepines can lead to withdrawal symptoms, including anxiety, insomnia, seizures, and rebound symptoms. Gradual tapering under medical supervision is recommended.
- where can I find more facts about CBT-I?
- You can find more information about CBT-I from healthcare providers,sleep specialists,and organizations like the National Sleep Foundation.
Disclaimer: This article provides general information and should not be considered medical advice. Consult with a healthcare professional for personalized guidance on benzodiazepine discontinuation and insomnia treatment.
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