**7.7 Benzodiazepine receptor agonists**

This class of drugs binds to GABA (gamma aminobutyric acid)-A receptors and has sedative/hypnotic, amnestic, anxiolytic, muscle relaxant, and anticonvulsant effects. Many studies show that this GABA-mediated pharmacological activity favors sleep quality, reduces sleep latency, and wakefulness after sleep onset and improve total sleep time. Half-lives of BzRAS vary from short and intermediate to long, and therefore indications for sleep disturbance and insomnia depends of its clinical aspect (onset, maintenance, or end-stage insomnia) as well as their expected adverse effects (cognitive impairment, low attention levels, anterograde amnesia). Some controversies persist however regarding clinical improvements using these drugs on the long term. Long-term adverse reactions involve the increase in depressive symptoms, cognitive and psychomotor slowing. Its abrupt stop should not happen as rebound insomnia and seizures could appear or increase in intensity. Tolerance and dependence are also issues important to consider and in clinical practice it should be avoided to prescribe more than one benzodiazepine at the time since metabolites can combine and prolong sedation time. BzRAS should not be a first option in non-controlled patients with sleep disordered breathing as they can disturb respiratory responses and therefore increase severity of sleep-related respiratory disturbances. Finally, it is crucial to appropriately taper the BzRA in order to prevent associated deleterious effects in comparison of their probable short time advantage [83].
