When older adults take benzodiazepines, the expectation is improved sleep quality. But new research shows the opposite: benzodiazepine use in seniors is linked to worsened sleep quality, reduced deep sleep, and increased risk of cognitive decline and falls.
What are benzodiazepines and why are they prescribed?
Benzodiazepines (often shortened to “benzos”) are a class of medications commonly prescribed for anxiety, insomnia, and other conditions. Some well-known brand names include Valium, Xanax and Ativan. The class also includes benzodiazepine receptor agonists (BZRAs) used as hypnotics. These medications act on the GABA-A receptor in the brain, producing sedative, hypnotic, anxiolytic and muscle-relaxant effects.
In younger adults, short-term benzodiazepine use can help with insomnia or acute anxiety. But in older adults, the story is different.
The recent research: chronic benzodiazepine use in seniors and sleep architecture
A recent study carried out at Concordia University in Montréal (led by Loïc Barbaux and Thanh Dang‑Vu) found that in older adults (aged ~55-80) who chronically use benzodiazepines or BZRAs (≥3-times/week for >3 months), sleep quality is actually worsened compared to those with insomnia not using these medications, or good sleepers.
Key findings:
- The group using benzodiazepines (MED) had lower amounts of deep sleep stage N3 and higher amounts of lighter sleep (stage N1) compared with non-medicated insomnia and good sleepers.
- The study measured sleep via overnight polysomnography (PSG), analysing macro‐architecture (sleep stages) and micro-architecture (EEG slow oscillations, spindles and coupling) critical for memory consolidation.
- Higher doses of benzodiazepines correlated with more severe disruption in sleep architecture and brain oscillations.
Why deep sleep matters for older adults
Deep sleep—also called slow-wave sleep (stage N3)—is crucial for memory consolidation, brain repair, and overall cognitive health. During deep sleep, slow brain-waves, decreased heart rate and breathing occur, allowing the brain to process and solidify memories.
When deep sleep is reduced (as in the benzodiazepine-using group), older adults may lose a key mechanism of brain maintenance and memory health, increasing risk of cognitive decline.
The impact: sleep quality, cognition and falls risk
Because benzodiazepine use in seniors affects both macro and micro-sleep architecture, several downstream risks emerge:
- Impaired memory and cognition: Since slow-wave sleep and spindle coupling are altered, memory consolidation may be compromised. The authors conclude that chronic BZD/BZRA use may mediate the link between sedative-hypnotics and cognitive impairment in older adults.
- Increased risk of falls and fractures: Older adults are more vulnerable to sedative effects and residual impairments from benzodiazepines (e.g., gait instability, dizziness). Independent commentary by the same research group highlights dependence, cognitive decline, road accidents and falls as risks.
- Worsening insomnia rather than improvement: Although patients may feel subjectively that their sleep is better, objectively the sleep structure is poorer. As the researchers state: “These drugs don’t even improve the sleep of the older adults using them on the long-term.”
Clinical implications: what should health professionals and older adults know?
- The American Geriatrics Society recommends that benzodiazepines be avoided entirely in adults aged over 65 years, due to increased adverse effects.
- For older adults currently on benzodiazepines: a gradual taper over months plus a behavioural intervention (eg. Cognitive Behavioural Therapy for Insomnia (CBT-I)) is advised, rather than abrupt discontinuation which can trigger rebound insomnia and withdrawal.
- Non-pharmacological alternatives (like CBT-I) should be first-line for insomnia in older adults, rather than defaulting to benzodiazepines.
- For prescribing professionals: review older patients on benzodiazepines or BZRAs for chronic use, fall risk, cognitive impairment and consider deprescribing where appropriate.
Tips for older adults and their caregivers
- If you are aged 65+ and using a benzodiazepine for sleep or anxiety, ask your healthcare provider about the risks and whether a safer alternative exists.
- Keep a sleep diary: note how long you sleep, wake–after-sleep onset, subjective quality. Compare if you taper medication.
- Improve sleep hygiene: consistent bed/wake times, limit caffeine, avoid screens before bed, ensure the bedroom is cool, dark and quiet.
- Ask about CBT-I or other behavioural sleep therapy as a safer, evidence-based alternative.
- Monitor and mitigate fall risk: any medication causing sedation, dizziness or confusion increases fall risk in older adults.
Summary
While benzodiazepines may appear to offer relief for insomnia and anxiety, in older adults they can lead to worsened sleep architecture, reduced deep sleep, diminished memory consolidation, and elevated fall and cognitive decline risk. The recent study from Concordia University underscores that in seniors, the use of benzodiazepines (and BZRAs) often does more harm than good to sleep quality and brain health. Avoiding or tapering these medications in older adults, and instead relying on behavioural therapies like CBT-I, is a safer and more effective path.
Disclaimer: This blog is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before making changes to medication or treatment plans.