Constance Fung, MD, MSHS

Masked Taper + CBT-I Helps Patients Rethink Sleep Med Needs, with Constance Fung, MD

sat down with Constance Fung, MD, MSHS, from the David Geffen School of Medicine at UCLA, to discuss her 

, “Impact of Benzodiazepine Receptor Agonist Masked Tapering Combined with Augmented CBTI on Daytime Sleepiness and Patient-Reported Sleep Quality.” During the interview, Fung shared how these findings inform deprescribing practices or guideline development for long-term benzodiazepine (BZRA) users with 

“We're really excited about the prospects of further implementing a masked tapering approach with augmented CPT-I,” Fung said.

Fung and colleagues created a Masked Taper plus cognitive behavioral therapy-augmented program (MTcap) to minimize placebo effects and boost discontinuation. A multi-site trial compared 8 weeks of MTcap with standard, gradual tapering in 188 adults aged ≥ 55 years (mean age, 69.2 years; 34.6%) female) who were on alprazolam, lorazepam, temazepam, or zolpidem for ≥ 2 nights per week and for ≥ 3 months. On average, participants used a BZRA 5.9 days a week.

In the study, MTcap resulted in greater BZRA discontinuation 6 months after treatment (73.4%) compared with standard tapering (58.6%). Insomnia severity improved for both arms, with baseline Epworth Sleepiness Scale scores increasing from 6.32 and 6.21 at baseline for MTcap and standard taper, respectively, to 3.98 and 3.92 at 1 week and 4.54 and 3.91at 6 months. Pittsburgh Sleep Quality index scores also showed improvements from baseline to week 1 and month 6 in both arms.

“I think one of the key elements of the masked tapering program was [that] we had this diary, and we'd ask people, what do you think you were taking on a [nightly] basis, compared to your baseline dose,” Fung said. “We're getting them to challenge their thoughts about their medication.”

Fung said she wants patients to ask themselves, “Is this pill really doing something for me?” After patients finish a MTcap program, they should recognize they are not sleeping well and maybe need a sleeping pill.

“I want them to be challenging that thought,” Fung said. “We'll need to do more analyses to try to get a better picture of exactly what was going on, but I really think that that is one of the reasons why the discontinuation rates were sustained long term.”

Fung has no relevant reported disclosures.

Ereso J, Alessi C, Martin J. Impact of Benzodiazepine Receptor Agonist Masked Tapering Combined with Augmented CBTI on Daytime Sleepiness and Patient-Reported Sleep Quality. Late breaker was presented at SLEEP 2025 the 39th annual meeting of the Associated Professional Sleep Societies, from June 8 – 11, 2025 in Seattle.

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At SLEEP 2025, Fung discussed how combining a masked taper, CBT-I, and a nightly dose-tracking diary helped older adults achieve long-term benzodiazepine discontinuation.

Masked Taper + CBT-I Boosts Benzodiazepine Discontinuation, with Constance Fung, MD

SLEEP 2025, the 39th annual meeting of the Associated Professional Sleep Societies

 spoke with Constance Fung, MD, MSHS, from the David Geffen School of Medicine at UCLA, on her team’s late-breaker, “Impact of Benzodiazepine Receptor Agonist Masked Tapering Combined with Augmented CBTI on Daytime Sleepiness and Patient-Reported Sleep Quality.”

struggle to discontinue benzodiazepine (BZRA) receptor agonists. Benzodiazepine is linked to several risks, including falls and hip fractures.

 A team from UCLA created a Masked Taper plus cognitive behavioral therapy-augmented program (MTcap) to target placebo effects and boost discontinuation.

“We had more people discontinue their benzodiazepine… 6 months following the end of the intervention in the MTcap group than the standard group, and in spite of that, both arms, there was this reduction in insomnia severity and improvement in sleep quality, as well as improvement in daytime sleepiness,” Fung said.

Fung and colleagues compared a masked tapering approach with augmented CBT-I to a standard, open-taper with CBT-I. In January 2025, Fung and colleagues expanded their analysis to evaluate the impact of MTcap compared with supervised gradual taper on daytime sleepiness and sleep quality.

The team conducted a multi-site trial at an academic health center and California's Department of Veteran Affairs medical center. The sample included 188 adults aged ≥ 55 years (mean, 69.2 years; 34.6% female) who used alprazolam, lorazepam, temazepam, or zolpidem for ≥ 2 nights per week and ≥ 3 months; on average, participants used BZRA 5.9 days per week. Participants were randomized to receive 8 sessions of MTcap or supervised gradual tapering.

Blinded staff members administered the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) at baseline, 1 week post-treatment, and 6 months post-treatment.

The study showed that MTcap resulted in greater benzodiazepine discontinuation 6 months after treatment (73.4%) compared with cognitive behavioral therapy for insomnia (CBT-I) and supervised gradual (unmasked) taper (58.6%). From baseline scores of 6.32 (MTcap) and 6.21 (standard taper), both groups showed improved ESS insomnia severity at 1 week (3.98 vs 3.92) and 6 months (4.54 vs 3.91), respectively. PSQI scores also improved from 12.10 vs 3.91 at baseline to 7.26 vs 7.36 at 1 week, and 7.55 vs 7.92 at 6 months, respectively.

“Both arms received cognitive behavioral therapy for insomnia—that was embedded in both arms— and we know that CBTI can help people who have underlying insomnia,” Fung said. “There's…no difference between the arms…probably because we know CBTI does work. Keep in mind, again, that if you don't need to use a medication that increases your risk, and you're also having some improvement in your sleep quality and reduction in daytime sleepiness, then that really speaks to the benefits of the masked tapering with the augmented CBT.”

Derman, C. Current Interventions Fail to Reduce Benzodiazepine Use in Older Adults. HCPLive. November 2, 2024. 

https://www.hcplive.com/view/current-interventions-fail-reduce-benzodiazepine-use-older-adults

At SLEEP 2025, Fung shared that masked taper plus CBT-I led to higher benzodiazepine discontinuation and improved sleep in older adults.

Constance Fung, MD, MSHS

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