In a trial of long-term benzodiazepine users, 27% had stopped the medication within six months. The intervention was a leaflet explaining the risks. No doctor was involved in delivering it.
That result — from the EMPOWER trial — is the reason this page exists. The finding underneath it was that most long-term users had simply never been told there was anything to be concerned about.
What These Medications Are
Two related groups come up most often for sleep and anxiety in older adults.
Benzodiazepines — among the most consistently implicated drug classes in fall research. Often prescribed decades ago for a short course, and still being taken.
Sedative-hypnotics, sometimes called Z-drugs, including zolpidem, eszopiclone, and zaleplon. Marketed as a gentler alternative. The fall data does not support treating them as meaningfully safer.
Both work by slowing central nervous system activity. That is the therapeutic effect and the problem in the same mechanism: the sedation that produces sleep also slows the reaction that keeps you upright when your foot catches.
Why They Matter for Falls
Recovering from a stumble is a reflex measured in fractions of a second. Sedation lengthens that fraction. Nothing about the hazard changes — the margin for recovering from it does.
The effect does not politely end at breakfast. Many of these drugs have a duration of action that carries impairment into the following morning, which is why the risk is not confined to a night-time trip to the bathroom.
Two situations carry particularly elevated risk: starting one of these medications, and increasing the dose. Risk is concentrated in the weeks after a change.
The Long-Term Use Problem
These drugs were designed for short courses — typically a few weeks. In practice, a great many people take them for years.
Two things happen over that time. Tolerance develops, so the sleep benefit fades while the sedation persists. And physical dependence builds, so stopping becomes genuinely difficult — which is often misread by the person as proof they still need it.
The result is a medication that may no longer be helping sleep much, still carries its full fall risk, and feels impossible to stop. That is a good reason to have the conversation, not a reason to avoid it.
What a Taper Actually Involves
This is the part people most want to know, and the part where specifics belong with a clinician rather than a website.
What can be said generally: reducing these medications after long-term use is done gradually and under supervision, typically over weeks to months rather than days. The dose comes down in steps, with time at each step. Some people switch to a longer-acting equivalent first to make the reduction smoother. Timelines vary enormously depending on the drug, the dose, and how long it has been taken.
What matters more than the schedule is that there is one, agreed with the prescriber, with a plan for the difficult stretches.
Do not stop abruptly. Sudden withdrawal from benzodiazepines after long-term use can cause severe symptoms including seizures. This is not a cautionary formality — it is the specific reason this must be supervised.
It is also normal for sleep to get worse before it gets better. Rebound insomnia during a taper is expected and temporary, and knowing that in advance is a large part of getting through it.
What Replaces It
A taper works better when something takes the medication’s place.
For insomnia, the treatment with the strongest evidence in older adults is cognitive behavioural therapy for insomnia (CBT-I) — a structured, short programme, not open-ended counselling. It outperforms sleep medication over the long term and is available in group, online, and app-based formats. It is worth asking about by name.
Alongside it: consistent sleep and wake times, daylight exposure early in the day, physical activity, and limiting caffeine and alcohol.
One thing to avoid substituting: over-the-counter sleep aids. Most rely on sedating antihistamines, which carry their own fall risk and anticholinergic burden. Swapping a prescription sedative for a pharmacy one is not a reduction in risk.
Preparing for the Conversation
Print this, fill it in, and take it with you. In the EMPOWER trial, roughly six in ten people who received the information started the conversation themselves.
Sleep & Sedative Medication Review Sheet
Bring this to your doctor or pharmacist. Filling it in beforehand makes the appointment considerably more useful.
1. What I take
| Medication | Dose | How often | How long I’ve taken it |
|---|---|---|---|
2. Is it still working?
How long does it take me to fall asleep now?
How many hours do I actually sleep?
How do I feel the next morning — groggy, foggy, unsteady?
Has it worked less well over time?
3. Warning signs
Falls or near-falls in the past year:
Have I ever felt unsteady getting up at night?
Have I tried to stop before? What happened?
4. Questions to ask
Is this medication increasing my risk of falling?
Do I still need it, or could we reduce it?
If we reduce it, how slowly, and what should I expect?
Can I be referred for CBT-I — cognitive behavioural therapy for insomnia?
What should I do if the first weeks are difficult?
5. What we agreed
Next review date:
Senior Health News · dontfall.com · Educational information only, not medical advice. Never stop or reduce a benzodiazepine or sleep medication without medical supervision — abrupt withdrawal can be dangerous.
A Note on Why This Is Worth Doing
The point of reducing a sedative is not subtraction for its own sake. It is what comes back.
A person who is less foggy in the morning walks more. Walking more preserves leg strength and balance — the strongest protective factors there are. The medication review is not about making someone more careful. It is about returning the alertness that lets them keep moving.
And if after a full and honest review the medication turns out to be the right thing to continue, that is a legitimate outcome. The goal is a decision that has actually been made, rather than a prescription that has simply never been questioned.
Related Guides
- Medications That Increase Fall Risk — the full guide this page belongs to
- How to Build a Complete Medication List
- Orthostatic Hypotension
- Balance & Strength Training
When to Speak to a Doctor
Raise this if you have taken a sleep or anxiety medication for more than a few weeks, if you feel groggy or unsteady in the mornings, if you have fallen or nearly fallen, or if you suspect the medication is no longer helping much.
Seek care promptly for severe symptoms during any reduction — marked agitation, confusion, tremor, or any seizure. These require immediate medical attention.
Sources
- Tannenbaum C, Martin P, Tamblyn R, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Internal Medicine, 2014. PubMed
- Deprescribing Psychotropic Medications and Falls in Older Adults: A Setting-Stratified Systematic Review and Meta-Analysis. PubMed
- Centers for Disease Control and Prevention. STEADI: Medications Linked to Falls. CDC
- Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults. Age and Ageing, 2022. Age and Ageing
Senior Health News publishes free educational guides on fall prevention, home safety, and healthy aging. This page is for general information only and is not medical advice. It does not replace evaluation by a qualified healthcare professional, and no product is sold or recommended on this site. Never start, stop, or change a medication without speaking to your doctor or pharmacist.
Last reviewed: September 8, 2026.