I’ve seen a fair number of elderly patients on benzos at bedtime. The patients claim that it calms their nerves and helps them sleep better.
To which I say, yeah, I’d like to have that, too.
Too often, benzos are used to treat symptoms, and do not address the underlying cause. For instance, I saw one 85 year old patient on TID Ativan, which is VERY IRRESPONSIBLE because it’s like throwing nitro patches on someone with new angina and not doing a stress test.
Benzos are appropriate for people with:
- short-term treatment of anxiety disorders
- insomnia for short bouts (2-4 weeks, dosed intermittently) although patients can get rebound insomnia
- maintenance benzos can be used in people who are refractory to other treatments or who have already become dependent and would have a difficult time withdrawing
Here are some guidelines when prescribing benzos:
- If it’s the first time someone is taking benzos, don’t prescribe for more than 1 month at a time
- Always use the lowest effective dose
- If someone is on maintenance benzos, use a long-acting one and do not exceed the equivalent of 15 mg of diazepam daily
- In elderly patients, avoid long-acting benzos (these can cause cognitive and gait abnormalities and sedation). Make sure you are not treating depression with benzos, because this will only make it worse.
If a person on high-dose, daily benzos comes into the hospitals, do not stop their benzos as this can precipitate withdrawal. But see if they’d be willing to start on a taper, or reduce their benzos.