Deprescribing benzodiazepine receptor agonists for insomnia in older adults – Authors' reply

We appreciate Antoine Christiaens and colleagues’ Correspondence on our Series paper regarding the assessment, diagnosis, and treatment of insomnia. Their Correspondence highlights that care should be taken with respect to the management of insomnia in older adults, specifically regarding the use of pharmacotherapy and the implementation of deprescribing. Although cognitive behavioural therapy should be the first-line treatment (regardless of age cohort), it is advisable to consider deprescribing before the initiation of cognitive behavioural therapy or represcribing in cases where older adults are being maintained on benzodiazepines or benzodiazepine receptor agonists, particularly in cases where there is increased risk for falls, disorientation, or parasomnias. The medical management of insomnia in older adults is complicated by a number of factors including comorbidity, existing medication regimens, the tendency towards advanced sleep phase, the higher incidence of napping, highly variable sleep–wake schedules, potentially histaminergic overactivity, or a combination of these..