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Published on: February 17, 2023
Risks Associated With Benzodiazepine Long-Term Use in Chronic Insomnia: A Systematic Review and (Network)
Dieter Riemann1, Chiara Baglioni1,2, Christoph Nissen3
1Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine University of Freiburg, Freiburg, Germany.
Journal of Sleep Research
|June 11, 2026
Summary
Long-term benzodiazepine use for chronic insomnia may worsen sleep quality and mental health. This review suggests prioritizing behavioral therapy and safer alternatives due to potential risks like increased depression and anxiety.
Area of Science:
- Pharmacology
- Sleep Medicine
- Mental Health
Background:
- Chronic insomnia significantly impacts daily functioning and quality of life.
- Benzodiazepines are commonly prescribed for insomnia but carry risks with prolonged use.
- Concerns include dependence, side effects, and long-term health implications.
Purpose of the Study:
- To systematically review the risks associated with benzodiazepine use exceeding 3 months in adults with chronic insomnia.
- To evaluate the impact on sleep quality, safety, mental health, and overall quality of life.
- To synthesize evidence from studies published between 1987 and 2023.
Main Methods:
- Systematic literature review of 27 studies.
- Included adults with insomnia symptoms lasting at least 3 months.
- Meta-analysis of outcomes: insomnia severity, sleep quality, falls, depression, and anxiety.
Main Results:
- Benzodiazepine users had more severe insomnia than healthy sleepers but less than non-medicated individuals.
- No significant difference in the risk of falls between benzodiazepine users and non-users.
- Benzodiazepine users reported significantly higher depression and anxiety levels compared to healthy sleepers.
Conclusions:
- Extended benzodiazepine use may negatively affect sleep quality, mental health, and quality of life.
- Evidence on long-term benzodiazepine use is limited.
- Findings support guidelines for limited use and suggest prioritizing behavioral therapy and safer pharmacotherapies.
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