clinical focus
medication, so they can become less inclined to bring it up during
the consultation. Also, older patients often have a number of
medical problems that need to be dealt with, so limited time could
play an issue in it not being covered during the consultation.
A combination of all of that often facilitates unintended
continuation of the tablets.
What should people be aware of if they do stop taking
benzodiazepines?
It would be important not to stop taking the medication without
first discussing it with their doctor – with any medication.
There can be some side-effects if benzodiazepines are stopped
suddenly, so it needs to be done in association with their doctor.
People need to be weaned off them over a period of time.
It’s also worth mentioning that one of the side-effects of
stopping benzodiazepines is you can get a rebound insomnia;
for a period of time after stopping the tablets, sleep can often
be disturbed. It’s a recognised side-effect of having come off
the medication. People should be educated that it’s a normal
experience and they shouldn’t restart the tablets. They should
persevere and it will settle down over time.
You also discovered that patients weren’t aware of some
alternative therapies on offer. What options can older
Australians look to for help?
It often depends on what the cause of their insomnia is, and
that’s something the doctor should discuss with the person.
From the study, we found [these drugs] were often initially given
out at a time of stress, so perhaps a bereavement, or a difficult
time in their lives. When we did the interview, often many years
after they’d been taking them, the cause of sleep [trouble] was
often something completely different. It could be pain from
arthritis, or it could be the need to get up to the bathroom.
Those are things that can be tackled in their own right with
different types of medications specifically for those causes.
If there isn’t an underlying cause, studies have shown that
cognitive behavioural therapy, through a psychologist, can be
useful in treating insomnia.
What are some of the conversations GPs and other health
professionals should have with people as they’re about to
start taking benzodiazepines?
They’re only for use in the short-term treatment of insomnia.
They’re not recommended for prolonged periods. As I said,
they stop being effective after about two to four weeks, and
they are addictive. People need to be warned that if they are
using them, they have the risk of addiction and there are
significant side-effects.
People presenting for repeat prescriptions should be [examined
to determine] the underlying cause of their sleep problems. Is
there something that could be better treated? And make the
patient aware that there are side-effects, benzodiazepines not
something you can take without risk. Determine whether there’s
an ongoing need to take the medication.
What else should health professionals take away from
the study?
It’s important to realise that in our study many of patients
were quite willing to consider stopping the medication, so the
perceived resistance to that may not be there. Be optimistic and
bring up the topic next time the patient presents for a script. ■
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