1 Pottie K, Thompson W, Davies S, Grenier J, Sadowski CA, Welch V, et al. Deprescribing benzodiazepine receptor agonists: evidence-based clinical practice guideline. Can Fam Physician. 2018 May;64(5):339–51.
2 Anthierens S, Tansens A, Petrovic M, Christiaens T. Qualitative insights into general practitioners views on polypharmacy. BMC Fam Pract. 2010 Sep;11(1):65.
3 Alexander GC, Sayla MA, Holmes HM, Sachs GA. Prioritizing and stopping prescription medicines. CMAJ. 2006 Apr;174(8):1083–4.
4 Holbrook AM, Crowther R, Lotter A, Cheng C, King D. Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ. 2000 Jan;162(2):225–33.
5 Canadian Institute for Health Information. Drug use among seniors on public drug programs in Canada, 2012. Ottawa, ON: Canadian Institute for Health Information; 2014. Available from:
https://secure.cihi.ca/free_products/Drug_Use_in_Seniors_on_Public_Drug_Programs_2012_EN_web.pdf
6 Vinkers CH, Olivier B. Mechanisms underlying tolerance after long-term benzodiazepine use: a future for subtype-selective GABAA receptor modulators? Adv Pharmacol Sci. 2012;2012:416864.
7 Farrell B, Tsang C, Raman-Wilms L, Irving H, Conklin J, Pottie K. What are priorities for deprescribing for elderly patients? Capturing the voice of practitioners: a modified delphi process. PLoS One. 2015 Apr;10(4):e0122246.
8 American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
9 Delini-Stuly A, Bischof R, Holsboer-Trachsler E. Sleep behavior of the Swiss population: prevalence and the daytime consequences of insomnia. Somnologie (Berl). 2007;11(3):193–201.
10 American Academy of Sleep Medicine. International classification of sleep disorders. Diagnostic and coding manual. Darien, IL: American Academy of Sleep Medicine; 2001.
11 Chung KF, Yeung WF, Ho FY, Yung KP, Yu YM, Kwok CW. Cross-cultural and comparative epidemiology of insomnia: the Diagnostic and statistical manual (DSM), International classification of diseases (ICD) and International classification of sleep disorders (ICSD). Sleep Med. 2015 Apr;16(4):477–82.
12 Morin CM, LeBlanc M, Bélanger L, Ivers H, Mérette C, Savard J. Prevalence of insomnia and its treatment in Canada. Can J Psychiatry. 2011 Sep;56(9):540–8.
13 National Institutes of Health. National Institutes of Health State-of-the-Science Conference statement on manifestations and management of chronic insomnia in adults, June 13-15, 2005. Sleep. 2005 Sep;28(9):1049–57.
14 Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008 Oct;4(5):487–504.
15 Wilson SJ, Nutt DJ, Alford C, Argyropoulos SV, Baldwin DS, Bateson AN, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol. 2010 Nov;24(11):1577–601.
16 Canadian Academy of Child and Adolescent Psychiatry, Canadian Academy of Geriatric Psychiatry, Canadian Psychiatric Association. Thirteen things physicians and patients should question. Toronto, ON: Choosing Wisely Canada; 2017. Available from:
www.choosingwisely canada.org/recommendations/psychiatry/
17 Canadian Geriatrics Society. Geriatrics: five things physicians and patients should question. Toronto, ON: Choosing Wisely Canada; 2017. Available from:
https://choosingwiselycanada.org/geriatrics/
18 American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63:2227–46.
19 Stephenson FA. The GABAA receptors. Biochem J. 1995 Aug;310(Pt 1):1–9.
20 Rosenberg HC, Chiu TH. Time course for development of benzodiazepine tolerance and physical dependence. Neurosci Biobehav Rev. 1985;9(1):123–31.
21 Sithamparanathan K, Sadera A, Leung L. Adverse effects of benzodiazepine use in elderly people: a meta-analysis. Asian J Gerontol Geriatr. 2012;7:107–11.
22 Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005 Nov;331(7526):1169.
23 Parr JM, Kavanagh DJ, Cahill L, Mitchell G, McD Young R. Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis. Addiction. 2009 Jan;104(1):13–24.
24 Gould RL, Coulson MC, Patel N, Highton-Williamson E, Howard RJ. Interventions for reducing benzodiazepine use in older people: meta-analysis of randomised controlled trials. Br J Psychiatry. 2014 Feb;204(2):98–107.
25 Voshaar RC, Couvée JE, van Balkom AJ, Mulder PG, Zitman FG. Strategies for discontinuing long-term benzodiazepine use: meta-analysis. Br J Psychiatry. 2006 Sep;189(3):213–20.
26 Pollmann AS, Murphy AL, Bergman JC, Gardner DM. Deprescribing benzodiazepines and Z-drugs in community-dwelling adults: a scoping review. BMC Pharmacol Toxicol. 2015 Jul;16(1):19.
27 Ramakrishnan K, Scheid DC. Treatment options for insomnia. Am Fam Physician. 2007 Aug;76(4):517–26.
28 Schünemann HJ, Wiercioch W, Etxeandia I, Falavigna M, Santesso N, Mustafa R, et al. Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise. CMAJ. 2014 Feb;186(3):E123–42.
29 Farrell B, Pottie K, Rojas-Fernandez CH, Bjerre LM, Thompson W, Welch V. Methodology for developing deprescribing guidelines: using evidence and GRADE to guide recommendations for deprescribing. PLoS One. 2016 Aug;11(8):e0161248.
30 Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al.; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008 Apr;336(7650):924–6.
31 Curran HV, Collins R, Fletcher S, Kee SC, Woods B, Iliffe S. Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life. Psychol Med. 2003 Oct;33(7):1223–37.
32 Morgan S, Smolina K, Mooney D, Raymond C, Bowen M, Gorczynski C, et al. The Canadian Rx atlas. 3rd ed. Vancouver, BC: University of British Columbia, Centre for Health Services and Policy Research; 2013.
33 Baillargeon L, Landreville P, Verreault R, Beauchemin JP, Grégoire JP, Morin CM. Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: a randomized trial. CMAJ. 2003 Nov;169(10):1015–20.
34 Belleville G, Guay C, Guay B, Morin CM. Hypnotic taper with or without self-help treatment of insomnia: a randomized clinical trial. J Consult Clin Psychol. 2007 Apr;75(2):325–35.
35 Garfinkel D, Zisapel N, Wainstein J, Laudon M. Facilitation of benzodiazepine discontinuation by melatonin: a new clinical approach. Arch Intern Med. 1999 Nov;159(20):2456–60.
36 Habraken H, Soenen K, Blondeel L, Van Elsen J, Bourda J, Coppens E, et al. Gradual withdrawal from benzodiazepines in residents of homes for the elderly: experience and suggestions for future research. Eur J Clin Pharmacol. 1997;51(5):355–8.
37 Morin CM, Bastien C, Guay B, Radouco-Thomas M, Leblanc J, Vallières A. Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. Am J Psychiatry. 2004 Feb;161(2):332–42.
38 Pat-Horenczyk R, Hacohen D, Herer P, Lavie P. The effects of substituting zopiclone in withdrawal from chronic use of benzodiazepine hypnotics. Psychopharmacology (Berl). 1998 Dec;140(4):450–7.
39 Shapiro C, Sherman D, Peck D. Withdrawal from benzodiazepines by initially switching to zopiclone. Eur Psychiatry. 1995;10(S3 Suppl 3):145s–51s.
40 Vissers FH, Knipschild PG, Crebolder HF. Is melatonin helpful in stopping the long-term use of hypnotics? A discontinuation trial. Pharm World Sci. 2007 Dec;29(6):641–6.
41 Voshaar RC, Gorgels WJ, Mol AJ, van Balkom AJ, van de Lisdonk EH, Breteler MH, et al. Tapering off long-term benzodiazepine use with or without group cognitive-behavioural therapy: three-condition, randomised controlled trial. Br J Psychiatry. 2003 Jun;182(6):498–504.
42 Paquin AM, Zimmerman K, Rudolph JL. Risk versus risk: a review of benzodiazepine reduction in older adults. Expert Opin Drug Saf. 2014 Jul;13(7):919–34.
43 Okuji Y, Matsuura M, Kawasaki N, Kometani S, Shimoyama T, Sato M, et al. Prevalence of insomnia in various psychiatric diagnostic categories. Psychiatry Clin Neurosci. 2002 Jun;56(3):239–40.
44 Neylan T, Reynolds C, Kupfer D. Sleep disorders. In: Hales RE, Yudofsky SC, editors. Textbook of clinical psychiatry. Washington, DC: American Psychiatric Publishing; 2003. p. 975–1000.
45 Wooten V, Buysse D. Sleep in psychiatric disorders. In: Chokroverty S, editor. Sleep disorders medicine: basic sciences, technical considerations, and clinical aspects. 3rd ed. New York, NY: Saunders; 2009.
46 Chang PP, Ford DE, Mead LA, Cooper-Patrick L, Klag MJ. Insomnia in young men and subsequent depression. The Johns Hopkins Precursors Study. Am J Epidemiol. 1997 Jul;146(2):105–14.
47 Ohayon MM, Shapiro CM. Sleep disturbances and psychiatric disorders associated with posttraumatic stress disorder in the general population. Compr Psychiatry. 2000 Nov-Dec;41(6):469–78.
48 Pigeon W. Insomnia as a risk factor for disease. In: Sateia MJ, Buysse DJ, editors. Insomnia: diagnosis and treatment. London, UK: Informa Healthcare; 2010. p. 31–41.
49 Chokroverty S. Clinical companion to sleep disorders medicine. 2nd ed. Boston MA: Butterworth-Heinemann; 2000.
50 Stamatakis KA, Punjabi NM. Effects of sleep fragmentation on glucose metabolism in normal subjects. Chest. 2010 Jan;137(1):95–101.
51 Merlino G, Gigli GL, Valente M. Sleep disturbances in dialysis patients. J Nephrol. 2008 Mar-Apr;21 Suppl 13:S66–70.
52 De Santo RM, Bartiromo M, Cesare CM, Cirillo M. Sleep disorders occur very early in chronic kidney disease. J Nephrol. 2008 Mar-Apr;21 Suppl 13:S59–65.
53 Grenier J. A decision tree approach to the differential diagnosis of insomnia. In: Billard M, editor. Sleep: physiology, investigations and medicine. New York, NY: Springer; 2003. p. 191–9.
54 Jansen J, Naganathan V, Carter SM, McLachlan AJ, Nickel B, Irwig L, et al. Too much medicine in older people? Deprescribing through shared decision making. BMJ. 2016 Jun;353:i2893.
55 Reeve E, To J, Hendrix I, Shakib S, Roberts MS, Wiese MD. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging. 2013 Oct;30(10):793–807.
56 Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014 Jun;174(6):890–8.
57 Vicens C, Bejarano F, Sempere E, Mateu C, Fiol F, Socias I, et al. Comparative efficacy of two interventions to discontinue long-term benzodiazepine use: cluster randomised controlled trial in primary care. Br J Psychiatry. 2014 Jun;204(6):471–9.
58 Schweizer E, Rickels K, Case WG, Greenblatt DJ. Long-term therapeutic use of benzodiazepines. II. Effects of gradual taper. Arch Gen Psychiatry. 1990 Oct;47(10):908–15.
59 Denis C, Fatseas M, Lavie E, Auriacombe M. WITHDRAWN: pharmacological interventions for benzodiazepine mono-dependence management in outpatient settings. Cochrane Database Syst Rev. 2013 Jun;6(6):CD005194.23780681
60 Gorgels WJ, Oude Voshaar RC, Mol AJ, van de Lisdonk EH, van Balkom AJ, Breteler MH, et al. Predictors of discontinuation of benzodiazepine prescription after sending a letter to long-term benzodiazepine users in family practice. Fam Pract. 2006 Feb;23(1):65–72.
61 Cormack MA, Owens RG, Dewey ME. The effect of minimal interventions by general practitioners on long-term benzodiazepine use. J R Coll Gen Pract. 1989 Oct;39(327):408–11.
62 Morin CM, Bélanger L, Bastien C, Vallières A. Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse. Behav Res Ther. 2005 Jan;43(1):1–14.
63 O’Connor K, Marchand A, Brousseau L, Aardema F, Mainguy N, Landry P, et al. Cognitive-behavioural, pharmacological and psychosocial predictors of outcome during tapered discontinuation of benzodiazepine. Clin Psychol Psychother. 2008 Jan-Feb;15(1):1–14.
64 Voshaar RC, Gorgels WJ, Mol AJ, van Balkom AJ, Mulder J, van de Lisdonk EH, et al. Predictors of long-term benzodiazepine abstinence in participants of a randomized controlled benzodiazepine withdrawal program. Can J Psychiatry. 2006 Jun;51(7):445–52.
65 Soldatos CR, Dikeos DG, Whitehead A. Tolerance and rebound insomnia with rapidly eliminated hypnotics: a meta-analysis of sleep laboratory studies. Int Clin Psychopharmacol. 1999 Sep;14(5):287–303.
66 van Rijnsoever C, Täuber M, Choulli MK, Keist R, Rudolph U, Mohler H, et al. Requirement of α5-GABAA receptors for the development of tolerance to the sedative action of diazepam in mice. J Neurosci. 2004 Jul;24(30):6785–90.
67 Busto U, Sellers EM, Naranjo CA, Cappell H, Sanchez-Craig M, Sykora K. Withdrawal reaction after long-term therapeutic use of benzodiazepines. N Engl J Med. 1986 Oct;315(14):854–9.
68 Rickels K, Schweizer E, Case WG, Greenblatt DJ. Long-term therapeutic use of benzodiazepines. I. Effects of abrupt discontinuation. Arch Gen Psychiatry. 1990 Oct;47(10):899–907.
69 Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016 Jul;165(2):125–33.
70 Agency for Healthcare Research and Quality. Effective Health Care Program: management of insomnia disorder. Rockville, MD: Agency for Healthcare Research and Quality; 2015. Available from:
https://effectivehealthcare.ahrq.gov/sites/default/files/related_files/insomnia_executive.pdf
71 Buysse DJ. Insomnia. JAMA. 2013 Feb;309(7):706–16.
72 Seyffert M, Lagisetty P, Landgraf J, Chopra V, Pfeiffer PN, Conte ML, et al. Internet-delivered cognitive behavioral therapy to treat insomnia: a systematic review and meta-analysis. PLoS One. 2016 Feb;11(2):e0149139.
73 Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann Intern Med. 2015 Aug;163(3):191–204.
74 Get your sleep back. Sleepwell Nova Scotia [website]; 2018. Available from:
http://sleepwellns.ca/get-your-sleep-back
75 Ritterband LM, Thorndike FP, Gonder-Frederick LA, Magee JC, Bailey ET, Saylor DK, et al. Efficacy of an Internet-based behavioral intervention for adults with insomnia. Arch Gen Psychiatry 2009 Jul;66(7):692–8.
76 Tyrer P, Murphy S, Riley P. The benzodiazepine withdrawal symptom questionnaire. J Affect Disord. 1990 May;19(1):53–61.
77 Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011 Dec;135(1-3):10–9.
78 Roth T, Jaeger S, Jin R, Kalsekar A, Stang PE, Kessler RC. Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication. Biol Psychiatry. 2006 Dec;60(12):1364–71.
79 Chung KH, Li CY, Kuo SY, Sithole T, Liu WW, Chung MH. Risk of psychiatric disorders in patients with chronic insomnia and sedative-hypnotic prescription: a nationwide population-based follow-up study. J Clin Sleep Med. 2015 Apr;11(5):543–51.
80 Bateson AN. Basic pharmacologic mechanisms involved in benzodiazepine tolerance and withdrawal. Curr Pharm Des. 2002;8(1):5–21.
81 Lam RW, Kennedy SH, Grigoriadis S, McIntyre RS, Milev R, Ramasubbu R, et al.; Canadian Network for Mood and Anxiety Treatments (CANMAT). Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy. J Affect Disord. 2009 Oct;117 Suppl 1:S26–43.
82 Bandelow B, Lichte T, Rudolf S, Wiltink J, Beutel ME. The German guidelines for the treatment of anxiety disorders. Eur Arch Psychiatry Clin Neurosci. 2015 Aug;265(5):363–73.
83 Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M; Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14 Suppl 1:S1.
84 Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014 May;28(5):403–39.
85 Canadian Medical Protective Association [website]. Risk management in elderly patients: medication issues. Ottawa, ON: Canadian Medical Protective Association; 2011. Available from:
www.cmpa-acpm.ca/en/advice-publications/browse-articles/2011/riskmanagement-in-elderly-patients-medication-issues
86 Canadian Medical Protective Association [website]. Adverse events – physician-prescribed opioids. Ottawa, ON: Canadian Medical Protective Association; 2009. Available from:
www.cmpa-acpm.ca/en/advice-publications/browse-articles/2009/adverse-events-physicianprescribed-opioids
87 Greenfield D, Brown J. Current medicolegal status of prescribing benzodiazepines: a special case. Natl Crim Justice Ref Serv 1995: 41–52.
88 Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al.; AGREE Next Steps Consortium. The Global Rating Scale complements the AGREE II in advancing the quality of practice guidelines. J Clin Epidemiol. 2012 May;65(5):526–34.
89 Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011 Jan;59(1):148–57.
90 Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012 Sep;9(9):CD007146.
91 Coussement J, De Paepe L, Schwendimann R, Denhaerynck K, Dejaeger E, Milisen K. Interventions for preventing falls in acute- and chronic-care hospitals: a systematic review and meta-analysis. J Am Geriatr Soc. 2008 Jan;56(1):29–36.