Discontinuation of benzodiazepines

I commend Lucie Baillargeon and colleagues1 for conducting their important and challenging study on discontinuation of benzodiazepine therapy in elderly patients. However, I have concerns about the control group, as described in the report. The physicians of patients whose benzodiazepines were gradually withdrawn in the control group “were not permitted to give advice on nonpharmacological treatments of insomnia.”1 Given the effectiveness of such interventions for chronic insomnia in older people,2^,3it is not surprising that cognitive–behavioural therapy combined with drug tapering was found to be superior to benzodiazepine withdrawal alone. What this study does not establish is whether cognitive–behavioural therapy is better than standard care, which would include, at a minimum, advice on sleep hygiene.2

Shabbir M.H. Alibhai University Health Network Toronto, Ont.