0431 Sleep Aid Usage Following Benzodiazepine Receptor Agonist Tapering and Cognitive Behavioral Therapy for Insomnia in Middle-Aged and Older Adults

Abstract Introduction A combination of medication tapering and cognitive behavioral therapy for insomnia (CBTI) improves benzodiazepine receptor agonists (BZRA) deprescribing success. However, discontinuing BZRAs may leave patients feeling like they need to use other non-BZRA sleep aids (e.g., melatonin). We aimed to describe temporal patterns of use of sleep aids from baseline to 6-month follow-up (6FU) associated with interventions that combined CBTI with BZRA tapering and to assess the odds of BZRA use at 6FU associated with non-BZRA use at baseline. Methods We analyzed diary data from a randomized trial (NCT03687086) that compared CBTI combined with a masked BZRA taper method (MTcap) versus standard open BZRA taper (SGT) to identify the frequency of four temporal patterns of sleep aids at 6FU relative to baseline: 1) “less BZRA-nonBZRA”, 2) “stable BZRA-nonBZRA”, 3) “more BZRA-nonBZRA”, and 4) “less BZRA/more nonBZRA.” We also assessed use of specific non-BZAs (e.g., melatonin) and whether non-BZRAs use at baseline predicted patterns of sleep aid usage at 6FU. Results Among 139 participants (71 MTcap; 68 SGT; mean age 69 years), 63% of participants were in the “less” category (68% MTcap, 59% SGT), 26% “stable” category (20% MTcap, 32% SGT), 5% “more” category (6% MTcap, 4% SGT), and 6% “less BZRA/more nonBZRA” category (7% MTcap, 4% SGT) at 6FU. Compared to BZRA only at baseline, combination BZRA-nonBZRA use at baseline had an increased odds of only nonBZRA use (OR = 9.05) and decreased odds of only BZRA (OR = .23) or no BZRA/nonBZRA (OR = .38) at 6FU. Conclusion The MTcap and SGT BZRA tapering programs, which both included CBTI, resulted in less use of sleeping aids overall. BZRA deprescribing programs that include CBTI are effective in reducing sleep aid use in middle-aged and older adults. Support (if any) VA IIR 17-234(CHF), R01AG057929(CHF), K24HL143055(JLM), RCS20-191(JLM)