Benzodiazepine Sleeping Pills After 65: What the Beers Criteria and the Label Say

Benzodiazepines, such as temazepam, lorazepam, alprazolam, clonazepam and diazepam, are sometimes prescribed for sleep and then refilled for years. If you’re over 65 and still taking one at bedtime, here is what two key sources say.

The Beers Criteria: avoid for most older adults

The American Geriatrics Society’s Beers Criteria list medicines that are often inappropriate for people 65 and older. For benzodiazepines, the recommendation is avoid.¹ The reasons:¹

• Older adults are more sensitive to these medicines and clear some of them more slowly.
• They raise the risk of memory problems, delirium, falls, fractures and car crashes.
• Long-term use can lead to physical dependence.
• Combining them with opioid pain medicines can cause dangerous sedation and breathing problems.

The criteria note they may still be appropriate for certain conditions, such as seizures, a specific sleep disorder called REM sleep behavior disorder, and severe anxiety.¹ The Z-drugs (zolpidem, eszopiclone, zaleplon) have similar risks in older adults.¹ Our guide to Z-drugs explains those.

What the label says

Temazepam is approved for short-term insomnia, generally 7 to 10 days, and its effectiveness trials lasted 2 weeks.² Its boxed warning covers:²

• serious risks when combined with opioids
• abuse, misuse and addiction
• dependence and withdrawal, which become more likely with longer use and higher doses

Stopping suddenly or cutting the dose fast after regular use can be life-threatening. The label calls for a gradual taper.²

If you’ve taken one for a long time

• Don’t stop on your own. Ask your prescriber about a slow tapering plan.
• Expect some sleep disruption while tapering, and plan support.
• Start CBT-I before or during the taper. Our guides to CBT-I and online CBT-I programs explain how it works.

Questions to ask

1. Why am I still on this, and is the reason still true?
2. What are my fall and memory risks on it?
3. What would a safe taper look like for me?
4. What can replace it, with or without medicine?

Our comparison of orexin-blocking sleep pills and our article on trazodone cover other options.

Try: “I’ve taken temazepam every night for eight years. I’m 68 and worried about falls. Can we make a slow plan to come off it?”

Did I Do That in My Sleep? includes a 14-Night Lights-Out Record and a Visit Brief. Use them to track sleep through any medicine change and note side effects. See the book.