Benzodiazepine Misuse in the Elderly: Risk Factors, Consequences, and Management.

Benzodiazepine (BZD) inappropriate use (i.e., misuse and overuse) is a worldwide public health problem. Despite current knowledge about increased sensitivity to side effects in the elderly, that should lead to more caution, only a third of BZD prescriptions in this age group are considered appropriate. The most frequent inadequate situations are excessive duration and/or dosage of a medical prescription or self-medication, especially in a context where it would be contraindicated, e.g., long-acting BZD in the elderly. Polypharmacy and comorbidities are major risk factors. Consequences of BZD inappropriate use are falls, delirium and other cognitive dysfunction, acute respiratory failure, car accidents, dependence, and withdrawal symptoms. An emerging concern is a potentially increased risk of dementia. Contrary to most clinicians' belief, discontinuation of chronic BZD use in elderly patients is feasible, with adequate psychotherapeutic or pharmacological strategies, and can lead to long-term abstinence. Brief cognitive therapy mostly relies on psychoeducation and motivational enhancement and is particularly useful in this context. Further research is needed, notably in three areas: (1) assessing the impact of public health programs to prevent BZD inappropriate use in the elderly, (2) developing alternative strategies to treat anxiety and insomnia in elderly patients, and (3) exploring the association between chronic BZD use and dementia.

Spontaneous K-complexes in chronic psychophysiological insomnia.

OBJECTIVE: Spontaneous K-complexes are electroencephalographic features unique to non-rapid eye movement sleep. It has been suggested that this phasic event is a sleep-protective mechanism. Because insomnia sufferers report poor sleep quantity and quality, the objective of this study was to document the occurrence of spontaneous K-complexes in Stage 2 sleep of individuals with chronic insomnia. Specifically, the number and density of spontaneous K-complexes were studied in psychophysiological insomnia sufferers. SETTING: This study took place in a sleep and event-related potentials laboratory. DESIGN: Spontaneous K-complexes were scored during Stage 2 sleep on the second and third nights of a four-consecutive-nights protocol of polysomnographic recordings. PARTICIPANTS: The sample included 14 participants suffering from psychophysiological insomnia (INS group; mean age=44.1 years) and 14 good sleepers (mean age=38.1 years). Participants underwent sleep and psychological evaluations. INS group participants met the diagnostic criteria for primary psychophysiological insomnia (mean duration of insomnia=9.6 years). INTERVENTION: Not applicable. RESULTS: The total number of spontaneous K-complexes and the density according to the total time spent in Stage 2 sleep (spontaneous K-complexes per minute) were compiled. Repeated-measures analyses of variance showed no significant difference in the number and density of spontaneous K-complexes between the INS group (313.98 and 2.66) and the GS group (361.10 and 2.88), respectively. CONCLUSION: These results suggest no deficiency in the sleep-protective mechanism of psychophysiological insomnia sufferers in comparison with good sleepers, as measured by the spontaneous K-complexes' number and density.

Sleep spindles in chronic psychophysiological insomnia.

OBJECTIVE: A sleep spindle is an electroencephalographic feature that is unique to sleep. It has been suggested that this phasic event has a sleep-protective function. The objective of the present study was to document one aspect of sleep protection in chronic insomnia sufferers: the number and density of sleep spindles in Stage 2 sleep. METHODS: Sleep spindles were scored during Stage 2 sleep on the second and third nights of a protocol of polysomnographic recordings that lasted for four consecutive nights. The sample included 16 participants suffering from insomnia (INS group; mean age=43.4 years) and 14 good sleepers (GS group; mean age=38.1 years). Participants underwent sleep and psychological evaluations. The INS group participants met the diagnostic criteria for primary psychophysiological insomnia (mean duration of insomnia=9.6 years). RESULTS: The total number of sleep spindles in Stage 2 sleep and the density (sleep spindles per minute) according to the total time spent in Stage 2 sleep were compiled. Repeated-measures analyses of variance showed no significant difference in the number and in the density of sleep spindles between the INS group (68.46 and 0.60, respectively) and the GS group (56.28 and 0.46, respectively). CONCLUSION: These results suggest no deficiency in the sleep-protection mechanism of psychophysiological insomnia sufferers in comparison with good sleeper controls, as measured by the number and density of sleep spindles.