Pilot RCT Testing A Mailing About Sleeping Pills and Cognitive Behavioral Therapy for Insomnia: Impact on Benzodiazepines and Z-Drugs
Open accessAbstract
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.
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Online CBT-I, evaluated in a single study involving an older adult population, did not prove effective in facilitating Z-drug discontinuation compared to controls after 6 to 12 months of follow-up.
“However, online CBT-I, evaluated in a single study 76 involving an older adult population, did not prove effective in facilitating Z-drug discontinuation compared to the controls after 6 to 12 months of follow-up.”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [76]
The Conclusions (page unavailable) report no significant reduction in active BZRA prescriptions at 6 or 12 months compared with controls; the study included z-drugs. But the intervention was a mailed brochure with information about accessing online CBT-I, not online CBT-I itself, and the outcome was active BZRA prescriptions rather than Z-drug discontinuation specifically. (LLM, conf=0.88)
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- Authors
- Mak, S. S., Alessi, C. A., Kaufmann, C. N., Martin, J. L., Mitchell, M. N., Ulmer, C., Lum, H. D., McCarthy, M. S., Smith, J. P., & Fung, C. H.
- Affiliations
- VA Greater Los Angeles Healthcare System (US)
- University of California, Los Angeles (US)
- University of Florida Health (US)
- Duke University (US)
- University of Colorado Anschutz (US)
- Denver VA Medical Center (US)
- VA Rocky Mountain Network (US)
- Corresponding author
- Mak, Selene S.
- ORCID
- Venue
- Clinical Gerontologist
- Publisher
- Informa UK Limited
- Published
- 2022-10-06
- Volume
- 47
- Issue
- 3
- Pages
- 452-463
- ISSN
- 0731-7115 (ISSN-L)
- 1545-2301
- PMC
- PMC10076445
- OpenAlex
- W4302290764
- Cited by
- 10
- References
- 27
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Gerontologist (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging
- Veterans Health Affairs Office of Rural Health
- U.S. department of veterans affairs
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- benzodiazepine receptor agonists, benzodiazepines, Z-drugs, cognitive behavioral therapy for insomnia, older veterans, drug risks
- MeSH terms
- Sleep Aids, Pharmaceutical, Aged, Benzodiazepines, Pharmaceutical Preparations, Humans, Sleep Initiation and Maintenance Disorders, Pilot Projects, Cognitive Behavioral Therapy
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