Benzodiazepines and Z-drugs raise the risk of falls, fractures and confusion in older adults. Cognitive behavioural therapy for insomnia is first-line, and simple measures help: regular wake time, limiting time in bed, daytime activity and light, and reviewing medicines, pain, nocturia and caffeine. Where an older adult is already on a benzodiazepine or Z-drug, plan a gradual taper with their agreement rather than an abrupt stop.
- Offer cognitive behavioural therapy for insomnia before any hypnotic.
- Review nocturia, pain, caffeine and medicines that disturb sleep.
- Avoid starting benzodiazepines or Z-drugs in older adults.
- Taper existing benzodiazepines or Z-drugs gradually with the patient's agreement.
Why it matters
A fall-related fracture from a sleeping tablet can cost an older adult their independence.
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