man with a confused and surprised expression

Can medications you take to get a good night’s sleep or ease anxiety increase your risk for Alzheimer’s disease or dementia? That was the scary question raised in a study published on September 27th, 2012 in the BMJ (formerly the British Medical Journal).

Benzodiazepines (benzos for short) are among the most widely prescribed drugs in the world. They are used to calm jittery nerves, ease anxiety, relieve stress and help people fall asleep.

According to the BMJ article, in France nearly one third of the people over 65 take a benzo. One fifth of those in Canada and Spain rely on such drugs. Here in the U.S. the numbers are also amazing. Millions of people take a daily dose of alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), oxazepam (Serax), temezepam (Restoril) or Triazolam (Halcion).

Then there are the so-called Z-drugs which are prescribed for sleep. An example is zolpidem (Ambien). Other Z drugs include zaleplon (Sonata) and eszopiclone (Lunesta). Tens of millions of prescriptions are filled annually for these sleeping pills. Like benzodiazepines, the Z-drugs also affect activity of a neurochemical called GABA and its brain receptors.

The French researchers investigated a possible link between benzos, Z-drugs and dementia. Between 1987 and 1989 they randomly selected 1063 older men and women from the southwest region of France who had no signs of dementia at the start of the study. These people (65 years of age and older) were interviewed face-to-face every two or three years for up to 20 years.

Trained neuropsychologists tested them for cognitive function and asked about psychological well being, health habits and medication usage. None of the participants took a benzo until at least three years into the study.
Here is what they found: Roughly one third of the benzodiazepine users (32%) were diagnosed with dementia (memory loss, difficulty thinking clearly, etc) sometime during the trial. Only 23% of nonusers got such a diagnosis. The investigators wrote:

“In this large, prospective, population based study of elderly people who were free of dementia and did not use benzodiazepines until at least the third year of follow-up, new use of benzodiazepines was associated with a significant, approximately 50% increase in the risk of dementia.”

The researchers controlled for things like depression, living alone, diabetes, hypertension and age, but the association with benzos persisted.

Now, we would be the first to point out that association does not prove causation. This was an epidemiological study, meaning that it was not the most foolproof research. But it is not the only study suggesting such a link.

The authors of this report point out that: “Our findings are consistent with three previous case-control studies that also showed an increased risk of dementia in benzodiazepine users.”

The latest Update on Benzodiazepines and Dementia:

Over the last few years other researchers have also looked for a relationship between such medications and dementia. A study published in May, 2015 (Expert Opinion on Drug Safety) asked the question:

Is there really a link between benzodiazepine use and the risk of dementia?

The researchers analyzed 10 observational studies and concluded that:

 “Out of the ten studies retrieved, nine reported an increased risk of dementia in benzodiazepine users. The risk increased with cumulative dose and treatment duration and when long-acting molecules were used…the body of evidence seems sufficient for avoiding prescriptions or renewals that are not fully justified and indiscriminate long-term use.”

Another meta-analysis of available research published in PLoS One (online, May 27, 2015) also concluded that long-term benzo use is associated with an increased risk of dementia. The authors note that:

“If confirmed, long-term benzodiazepine use should be considered as a critical public health issue in the context of the widespread use of benzodiazepines and the huge burden of dementia across many countries.”

What This Means:

The alarm bells are starting to ring that commonly prescribed sedatives just might be contributing to forgetfulness, cognitive dysfunction and dementia. In other words a giant experiment has been conducted on hundreds of millions of people worldwide for decades. We do not know for sure that these drugs cause Alzheimer’s disease, but we do not know for certain that they don’t. That scares us.

In the meantime, here are some things we do know.

Benzo Side Effects:

  • • Drowsiness, dizziness, fatigue, lethargy
    • Clumsiness, impaired coordination (not good for older people)
    • Memory problems
    • Cognitive impairment, difficulty concentrating
    • Dry mouth
    • Sexual difficulties
    • Low blood pressure
    • Depression
    • Difficulty stopping the drug

Getting Off Benzos Can Be Challenging!

One reason so many continue to take benzos for so long is that such drugs can be incredibly challenging to stop. When discontinued suddenly, symptoms can be almost unbearable.

Doctors used to say that it was just the underlying anxiety returning. We now know that these medications can rearrange neurochemicals in the brain. For some, it can take many weeks or months to return to “normal.”

Symptoms of Benzodiazepine Withdrawal:


  • Anxiety, restlessness, jitteriness, agitation
  • Irritability, sensitivity to sound, light and touch
  • Impaired concentration
  • Panic
  • Insomnia
  • Faulty memory
  • Depression
  • Headache
  • Fatigue
  • Muscle cramps
  • Muscle twitching
  • Seizures
  • Sweating
  • Diarrhea
  • Blurred vision
  • Decreased appetite

Unanswered Questions:

Is this association between benzos and dementia causative or just an association?

  • Which brain centers are affected and what could the underlying mechanism for cognitive dysfunction be?
  • Could there be some other underlying factors (such as anxiety) that are the real culprits?
  • Will younger people who rely on these drugs for years be at greater risk for dementia as they age?
  • Are there alternatives to benzos that could be effective for dealing with anxiety or insomnia?

If you would like to learn more about benzodiazepines and strategies for weaning off such drugs we offer our FREE Guide to Psychological Side Effects. We hope it will facilitate a conversation with your physician.

You may also find our Guide to Getting A Good Night’s Sleep of interest.

And we would like to hear your story. Please comment below if you have pros or cons to share about benzodiazepine-type drugs. If you have had trouble getting off benzos, share that story too.

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  1. Ann
    Charlotte
    Reply

    Interesting

  2. K
    Reply

    What was the dose and how many other meds did the people in these studies have in common?

  3. MARIE
    NC
    Reply

    I wonder if over the counter sleeping aids called PMs like Advil PM Aleve PM etc. could cause forgetfulness remembering names of Football teams or something that you are usually familiar with and can’t think of it quickly in a conversation. PM’s do help me sleep but are they not a good idea? Could PM’s start dementia?

  4. K
    54601
    Reply

    My mother had alzheimers. She was never on a benzo or a sleep med. She was however on statins for years. I suppose I might then think that could have caused it. Who knows. I take a benzo for anxiety. I also have muscle issues from a very bad back. It helps with muscle spasms as it relaxes the muscles. I use the medicine responsibly and feel it allows me to live a normal life with less fear and pain. That is more important to me then a maybe.

  5. Patricia
    Canada
    Reply

    For people who would like to discontinue the use of benzodiazepines the site below is probably the best there is for all the necessary information and encouragement –

    http://www.benzo.org.uk/manual/bzcha02.htm

  6. naomi
    queens, ny
    Reply

    I turned to drugs as the last resort and I finally found the ones to work. They are anti anxiety drug with melatonin. I went without sleep for so long I was a walking zombie. There are more car accidents due to lack of sleep. I think it is a brain disorder. Some people fall asleep easily and the other type seem to overthink. The brain does not shut down. When you have headache you take an aspirin. The whole aim is that good restorative sleep enables you to feel less depressed and you are able to function. It is not a weakness to take pills. When you do not sleep, you feel anxious.

  7. Cindy M. Black
    Seattle, WA
    Reply

    In reading the article and comments, not one reference to “taking benzos” mentioned HOW MANY benzos.

    Being high-strung, I’ve always had trouble sleeping. Finally, after MUCH experimentation, I discovered an OTC supplement (well, it’s Schiff’s “Knock-Out,” to be exact) which does the trick. Yay! However, when I’m away from home, around other people, or have to get to bed earlier than usual, I still cannot sleep! So I take a 5-mg or 10-mg tab of Ambien. This happens maybe once every 2 weeks. So my question is: is the damage kinda pro-rata? Or would taking any benzos at all set up some kind of predilection for Alzheimer’s? (assuming there is, in fact, a causal relationship).

    I’ve noticed many times that, when various statistics are cited regarding probable health impacts (+ or -) connected to the use of a certain substance, it seems like there’s ONE OF TWO MAJOR WAYS those statistics are arrived at. IN THE FIRST, effects of using the substance are pro-rata, i.e., the amount one uses is directly connected to the amount of impact. IN THE SECOND, use of the substance may or may not catalyze something else happening, like the development of a certain disease or disorder, etc. You may get the thing, or you may get off scott-free… and if you get off scott-free, there aren’t any other negative effects to worry about even though you may have used the substance copiously.

    Quite often, this distinction is simply not well addressed, or you have to really dig around to find it. (e.g., a big component of the mortality statistics re use of Ambien in older people has been not Alzheimer’s, but deaths from falls!)

    Anyway, I have digressed. But I’d still like to know whether I can consider myself pretty safe taking only 1 Ambien every 2 weeks. Thanks and Happy New Year!

  8. J. David Auner
    Springfield, MO, USA
    Reply

    Any pill active during the hours of sleep can cause dementia if it disrupts the sleep cycles particularly REM sleep. During REM sleep, memory files are compared and duplicate files are deleted. Without this housekeeping task, the brain quickly fills up with disorganized files which is usually a reversible dementia.

    From statins, Topamax, to benadryl and benzos, many people are susceptible to sleep disturbance from these drugs. Some big pharma drugs did not get sleep studies done because they would not have been approved if that evidence appeared. Doctors largely quit using Mevacor in favor of Zocor because of sleep disturbances but that collective knowledge was forgotten when Mevacor was available generically and greedy insurance companies insisted on its use. Sleep studies are underutilized in preventing dementia.

  9. Sandy
    Reply

    I should have said that maybe Margaret Thatcher might have taken Xanax since it only lasts about 4 hours, but I don’t know.

  10. Sandy
    Reply

    Lack of sleep can also contribute to dementia. Margaret Thatcher slept for 4 hours per night and got dementia. Some people have committed suicide because they had severe insomnia. All of that conventional wisdom contained in those guides to getting a good night’s sleep does not always work. We live in a world governed by chance.

  11. Mimi
    North Carolina
    Reply

    I have been using Restoril to help me sleep for about 4 years now. I absolutely do not sleep at all unless I take it. I have definitely noticed loss of concentration, memory and mental clarity. I used to be considered a very “smart” person, but with the short-term memory loss, I certainly don’t consider myself to be very smart anymore. I wish I could get off them completely, but what do you do when you can’t sleep without a sleeping aid?? I certainly don’t want to have dementia, but going without sleep causes lots of other problems too.

    • Terry Graedon
      Reply

      You may need a health professional to help you get off the pills. Cognitive behavioral therapy has been shown to be useful against insomnia (without side effects) but you’ll probably have to get through the rebound insomnia from withdrawal first.

  12. Sheri
    WA
    Reply

    I would like to know if Dementia symptoms start while taking a benzo or 20 years later. I took clonazepam for rls for 15 years with no negative effects. I quit cold turkey with only one bad effect..insomnia. And, of course, my rls returned. Seems to me I would have had symptoms of dementia after 15 years, but maybe that’s still to come. I took only 0.5 at bedtime in all those years. I’m 70 years old and worried!

    • Terry Graedon
      Reply

      The research looked only at people who were currently taking benzodiazepines, not those who had taken them years before. We suspect you may be all right.

  13. Fay
    Fayetteville, NC
    Reply

    I took Klonopin (a benzo) for years to prevent panic attacks. Since the publicity about its link to Alzheimer’s, I’ve been weaning off it slowly–as in 1/4 tablet reduction per month. Even at this rate, there are withdrawal side effects. I am interested in knowing what people are taking instead of the benzos.

  14. Cgb
    Raleigh NC
    Reply

    I began taking 1 mg of Ativan at bedtime 14 years ago when diagnosed with cancer. The cancer is gone, but I was left with the addiction. Several times I tried to stop the drug. Doctor’s prescription was to stop the ativan and take an alternative drug immediately. Each time I would feel terrible thinking it was the new drug and continue with the Ativan.

    At the beginning of this year my doctor would not renew my prescription. He told me that long term use can lead to dementia. I was then determined to get off the Ativan. He gave me a limited prescription. I was able to get off the Ativan very slowly by weaning. It took me 3 months. My doctor was not very cooperative when I suggested following Dr. Ashton’s Manual. I even brought him a copy which he handed back to me.

    During the three months there were days that I went through withdrawal. This was one of the most difficult experiences of my life. I did succeed and and feel empowered by this. I have changed doctors since. I’m writing this in hopes of helping others.

  15. Merrily
    Ohio
    Reply

    I have taken xanax(.025) for over 30 years (I am 72) for panic attacks and for sleep when the mind needs calming down. I have never increased the dose all these years. Cannot take the depression drugs out there. They make me feel worse that is why I have to depend on Xanax. My mind works fine.

    My sister takes them she is ten years older. My mother took this drug or Valium before Xanax as long as I came remember but we have never abused. She died at 92 from heart failure but her mind was very intact. We don’t take this to feel euphoria only to feel like a normal person. Your study is not very conclusive when it comes to my family.

  16. loree
    NC
    Reply

    Totally agree with this article! I took a Benzo for sleep for 2 years. Not knowing that I was becoming chemically dependent went off them and it through me into a bizarre world. My doctor who prescribed them to me did not recognize the problem I was having. Took lots of google research to see what my problem was. Took me a year to get my body functioning normal once again.

    Doctors have no clue how powerful these drugs are and the consequences of taking them. Warning to all! Do not stop cold turkey, very dangerous to do that.

  17. Julia
    Tennessee
    Reply

    15 years ago, my father, a very reluctant pill taker, told me that 1/2 of a Serax (brand name at the time) tablet helped his anxiety at night, and he only took that periodically. He knew even then that it had the shortest life in the body of all that type of drug.

    I have never forgotten that (because he was a man worth listening to) and in 2003, I got a prescription for Serax (brand name.) I am also a hesitant pill taker and would take 1/3 to 1/2 tab every now and then before or after an exceptionally stressful event. It’s now 2015, and I am just now trying to get a new prescription. Turns out I can’t. Nothing but generic in the U.S. and only in capsule form which is not conducive to my control of dosage. Plus, I now don’t know where the med is made or of what safety/health oversight.

    I have long known that generics are NOT THE SAME, but pharmacists (and certainly doctors) are defensive of their territory and thus will not discuss with me a mere human. If anyone knows where I can get quality control Oxazepam (generic) please inform me.

    • Julia
      Reply

      Let me add, the book Worst Pills Best Pills II (it’s obviously an older version) is extremely informative and forthcoming and helped me choose what was least harmful, shortest lasting, etc.

  18. Nyla
    Minnesota
    Reply

    My mom was recently diagnosed with Alzheimer’s. She has been on both of these medications for years and now is being taken off of them. It is so scary to hear what medications can do to you. It is probably to late for my mom but I’m sure happy that other people might be saved from this horrible disease.

  19. DrMikey
    Reply

    I’ve been taking Halcion for 30 years with no ill effects that I’m aware of. However, I use it very little — typically 1/4 tablet to get back to sleep after waking in the mddle of the night, and usually only 2 or 3 times a month. I also take a larger dose — 1/2 tablet at bedtime — if I feel like I’m getting the flu, believing that good night’s rest is important for fighting it off. Seems to work.

    • Julia
      Reply

      I agree with you, that moderation(and good sense) are the key to making medicines work for us.

  20. mike
    Reply

    Benzos are intended to be used short term! I started on 1 mg of clonapin per day 10 yrs ago. Progressed to 3.5 per day and after a 1 yr taper switching over to Valium, have become benzo free. benzo use contributed to an 80lb weight gain-lost over 70lbs during wd. over time they effect your metabolism. Benzo use cost me over 30k.
    My memory has slowly returned but not at previous level. I don’t know long term effects. The wd was horrible w regular brain zaps. I worked w a physician exper w tapering and followed The Ashton Manual.
    We need more support groups for people wd from benzos. Few rehabilitation programs are adequate in helping benzo wd-its very protracted and does not fit into a 30 day program that most insurance covers. I strongly suggest that no one take any benzo beyond 6 months!
    There are options available that don’t have the level of toxicity caused by prolonged levels of benzo in the blood plasma and suppression of natural GABA production. GABA is a critical substance that regulates many physiological and cognitive functions. My impulse control was not good and there are other aspects of behavioral change I feel directly attributed to my benzo wd-overeating, saying offensive and inappropriate comments, lack of boundaries. I hope that others can learn and be proactive in harm reduction regarding these very dangerous substances that are insidiously deceptive.

  21. SC
    Reply

    Love your analysis.
    Feeling the same, 41 going on 42. Ha!

  22. Torrence
    Reply

    I have one comment on this subject already, but reading all of the other comments I thought I might have another one that might be of some help. My wife who takes a pill to help her sleep, has become a couch potato. Nothing I say to her about exercise, of which I do, helps. I believe that when you become a couch potato you WILL have many problems with your health. My wife hurts all the time just about everywhere. I love her dearly but I’m helpless with her situation.
    There are many factors to anyone’s health. Some people can take a certain pill without any effects, and another taking the same pill may have all kind of problems. But in reality we are our own worst enemy. I have anxiety, but believe the way I have lived my life caused most, if not all of it. We live in a fast paced life style and wonder why need pills to get by. It’s because we have chosen a life style that will demand a pill. The bible tells us to “be content with what you have”. I have yet to find anyone that fits the bill. Sorry for the long letter.

  23. KHS
    Reply

    BLK said:
    The question is: Is it the drug one takes for trouble sleeping and/or anxiety that increases dementia OR ARE PEOPLE WHO HAVE DIFFICULTY SLEEPING OR DEALING WITH ANXIETY AT HIGHER RISK OF DEVELOPING DEMENTIA REGARDLESS OF WHETHER THEY TAKE MEDICATIONS TO TREAT THEIR SYMPTOMS OR NOT?
    ———–
    This is *exactly* my question. If the people began taking the drug 3 years later, but had not earlier, it is perhaps because they began experiencing symptoms for which the drug provided help. In other words, the symptoms of difficulty sleeping may have appeared, indicating a problem, and the drug was prescribed subsequent to that issue.

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