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

At SLEEP 2025, the 39th annual meeting of the Associated Professional Sleep Societies, in Seattle, HCPLive 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.”1

Many older adults with insomnia struggle to discontinue benzodiazepine (BZRA) receptor agonists. Benzodiazepine is linked to several risks, including falls and hip fractures.2 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.”

Fung has no relevant reported disclosures.

References

1. 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.

2. 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. Accessed June 11, 2025.