From the Guidelines
The best benzodiazepine for treating insomnia is temazepam, as it is suggested for use in treating sleep onset and sleep maintenance insomnia in adults, based on trials of 15 mg doses 1. When considering benzodiazepines for insomnia, factors such as symptom pattern, past response, cost, and patient preference should be taken into account 1. Some key points to consider when prescribing benzodiazepines include:
- Temazepam has a relatively longer half-life and is more likely to improve sleep maintenance, but may also produce residual sedation 1
- Triazolam has been associated with rebound anxiety and is not considered a first-line hypnotic 1
- Treatment with benzodiazepines should generally be limited to 2-4 weeks when possible to prevent dependence
- Side effects of benzodiazepines include sedation, cognitive impairment, and risk of falls, particularly in older adults
- Patients should avoid alcohol while taking benzodiazepines and should never stop them abruptly after prolonged use due to withdrawal risks. It's also worth noting that other medications, such as eszopiclone and zolpidem, may also be effective for treating insomnia, but temazepam is a suggested option based on the provided evidence 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Benzodiazepine Use and Risks
- Benzodiazepines are widely prescribed drugs with a high potential for misuse and dependence 2, 3
- Common risks associated with benzodiazepine use include sedation, confusion, memory loss, depression, falls, fractures, and motor vehicle crashes 2
- Factors that increase the risk of adverse effects and misuse include other substance use disorders, using concomitant central nervous system medications, and central nervous system or pulmonary diseases 2
Treatment and Withdrawal
- Withdrawal symptoms such as anxiety, sleep disturbances, and agitation are common and often prolonged when stopping benzodiazepine use 2, 3
- Adjunctive treatment with antiepileptics, antidepressants, and pregabalin has been shown to lessen withdrawal symptoms 2
- Tapering with clonazepam is a current treatment for withdrawal, but future research is needed to explore alternative methods 3