Use of night-time benzodiazepines in an elderly inpatient population

Aim: To examine benzodiazepine prescribing for sleep induction in an elderly medical inpatient population to determine if hospital prescribing may have encouraged benzodiazepine use following discharge. Secondary objectives included assessment of quality of sleep in hospital compared with home and monitoring for possible benzodiazepine side-effects. Method: Inpatient and discharge prescribing of benzodiazepines used for sleep induction were recorded in two medical wards over a 3-month period. A questionnaire was used to obtain information on patients' sleep patterns at home and in hospital. A follow-up telephone survey at 2-3 weeks post-discharge was made for those patients who were prescribed benzodiazepine at discharge. Results: Benzodiazepines were prescribed for 20% of patients with 94% of prescriptions being for temazepam. Of the 54 patients prescribed benzodiazepines during admission, 57% were not taking a benzodiazepine at home prior to their hospital admission. At discharge, 14 patients were prescribed benzodiazepines for home use, eight of whom had not used them at home previously. On follow-up none of these eight patients expressed a desire to continue benzodiazepine use for sleep induction. There was a significant (P < 0.05) reduction in sleep onset latency and number of nocturnal awakenings in hospital when compared with home. There was no change in sleep duration and overall quality of sleep. There was an association between early morning insomnia and benzodiazepine use. Conclusion: Discharge prescribing of benzodiazepines was appropriately limited to temazepam and did not encourage home use in previous non users. Benzodiazepines (primarily temazepam) were effective in the short term for inducing sleep in the hospital setting, with little evidence of side effects.