The Rationale for, and Use of, Benzodiazepines for Insomnia

Insomnia is a prevalent, chronic, and disabling disorder without ideal first-line pharmacological agents. Nevertheless, benzodiazepines (BZs) are indicated as short-term treatments for insomnia, when cognitive-behavioral therapy is unavailable or ineffective. Although all BZs release sleep-promoting gamma-aminobutyric acid, they have different pharmacokinetic profiles, which influence their onset of action, efficacy, and side-effect profiles. Unfortunately, BZs are associated with a wide range of undesirable effects, including dependence, the propensity for drug withdrawal, cognitive impairment, and disinhibition. This review presents recent evidence on the clinical efficacy of BZs for insomnia, compares their use with other sedativehypnotics, and provides an overview of their adverse effects, especially in elderly individuals.