Pilot RCT Testing A Mailing About Sleeping Pills and Cognitive Behavioral Therapy for Insomnia: Impact on Benzodiazepines and Z-Drugs

ABSTRACT

Objectives

The aim is to pilot a low-touch program for reducing benzodiazepine receptor agonist (BZRA; benzodiazepines, z-drugs) prescriptions among older veterans.

Methods

Pilot randomized controlled trial consists of 2,009 veterans aged ≥ 65 years who received BZRA prescriptions from a Veterans Health Administration pharmacy (Colorado or Montana) during the prior 18 months. Active: Arm 1 was a mailed brochure about BZRA risks that also included information about a free, online cognitive behavioral therapy for the insomnia (CBTI) program. Arm 2 was a mailed brochure (same as arm 1) and telephone reinforcement call. Control: Arm 3 was a mailed brochure without insomnia treatment information. Active BZRA prescriptions at follow-up (6 and 12 months) were measured.

Results

In logistic regression analyses, the odds of BZRA prescription at 6- and 12-month follow-ups were not significantly different for arm 1 or 2 (active) versus arm 3 (control), including models adjusted for demographics and prescription characteristics (p-values >0.36).

Conclusions

Although we observed no differences in active BZRA prescriptions, this pilot study provides guidance for conducting a future study, indicating a need for a more potent intervention. A full-scale trial testing an optimized program would provide conclusive results.

Clinical Implications

Mailing information about BZRA risks and CBTI did not affect BZRA prescriptions.

KEYWORDS:

• Benzodiazepine
• insomnia
• aging
• deprescribing
• older adults
• mortality

Clinical Implications

• Clinicians and healthcare organizations interested in reducing BZRA use in older veterans should consider interventions that are more potent than a mailed brochure about the risks of BZRA and information about accessing CBTI.

• The addition of a telephone reinforcement call to the mailed brochure was not sufficient to reduce BZRA prescriptions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, SM, upon reasonable request.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/07317115.2022.2130849

Additional information

Funding

This work was supported by the NHLBI, the National Institute on Aging, Daniel Kripke Trust, the Veterans Health Affairs Office of Rural Health, and U.S. department of veterans affairs.