CI wake up in the middle of the night, often at the same time. Then you stay there, with an active mind and sleep that never comes back. It is one of the most common experiences after the age of 50. And more and more often the answer is one: a tablet. Yet, according to a study published in BMJ,prolonged use of benzodiazepines is associated with a increased risk of dementiaespecially when it becomes chronic. Other works su JAMA Internal Medicine have highlighted possible effects on memory and attention.
A link that does not indicate a direct cause, but which the scientific community invites us to consider carefully, especially after the age of 50. In this phase of life – between menopause, hormonal changes and more fragile sleep – benzodiazepines, such as those based on Lorazepambecome a simple solution to a complex problem: sleeping without waking up. But is it really like that? We’ll talk about it with Professor Laura Palaginimedical director, psychiatrist expert in sleep medicine and coordinator of the clinic dedicated to women’s life cycles and insomnia at the Pisa University Hospital.
The myth of dementia risk (to be clarified)
“In reality, more recent studies have shown that this link does not exist,” explains the professor Laura Palagini. «I’m happy that through this article we can dispel a myth. The studies that affirm this link are meta-analyses of large samples that do not take into account many factors, including personal ones, that can influence the risk of dementia, nor the fact that insomnia was more or less in remission.”
The point, according to the specialist, is another: «It is in fact the disturbed sleep to increase the risk. Some studies show that One night of sleep deprivation is enough to increase the accumulation of beta-amyloid. However, it is a personal predisposition, and it is true that good sleep can make the difference.”
After age 50: why sleeping becomes more difficult
In this phase of life, between menopause, hormonal changes and physiological changes, sleep changes.
«In women the hormonal changes which occur especially in perimenopause go to disturb sleep architecture and its general organization”, explains Palagini. «Good sleep lowers core body temperature, while disturbed sleep loses this control function. This creates a vicious circle between insomnia and vasomotor symptoms of menopause».
How much benzodiazepines are really used
The use of drugs is far from rare. «Some recent research has shown that above all in Italy and Spain the use of hypnotic benzodiazepines for long periods affects 15 to 20% of insomniacs, with 60% for more than three years» explains the specialist.
«In other European countries the healthcare system is organized in such a way as to control the times of use, preventing them from becoming prolonged. They are anyway drugs recommended by the guidelines for the short-term treatment of insomnia”.
Cognitive risks: what the studies say today
In recent years, fear of effects on the brain has created a lot of attention. But the most updated position is clearer: «Honestly, the most recent studies deny this link», clarifies Palagini. «Benzodiazepines have not been shown to increase the risk of dementia. It is simply important to sleep as well as possible to restore sleep functions, including those of our brain’s “scavenger”.
What are the alternatives?
Today there are different options, even for those who need more continuous treatment. “The latest insomnia guidelinesboth national and international, indicate among the drugs orexin regulators, the so-called DORAs (Dual Orexin Receptor Antagonists), GABA modulators – i.e. hypnotic benzodiazepines and so-called Z-drugs – and the melatonin agonistslike the melatonin 2 mg prolonged release“, explains. «Let it be i DORA and melatonin have data for the long-term treatment of insomnia.” But, the specialist reminds us, these drugs are also necessary prescribed by the psychiatrist on a case-by-case basis.
Quitting: why you shouldn’t do it alone
One of the most common mistakes is trying to stop medications on your own. «You must always rely on a specialist», underlines Palagini.
«You can’t do it alone or by hearsay. To treat sleep, as for hypertension, you go to the doctor: he knows what to do.”
The risk of doing it yourself
The message is clear: avoid improvisation. «Like all disorders, insomnia can be cured, but it is doctors who know how to do it. Do-it-yourself is not recommended in all pathologies.” And he adds a useful reference: «On the site of the Italian Society of Sleep Medicine all the sleep medicine centers in Italy to which you can refer are indicated.”
Who to contact
For a specialized sleep assessment, you can consult the list of AIMS accredited centers:
https://sonnomed.it/centri-di-medicina-del-sonno-accreditati-aims/.
