Sedatives are commonly prescribed to treat insomnia despite Choosing Wisely recommendations that recommend non-pharmacological approaches as first-line treatment. Sedatives are associated with serious risks and harms including falls, hip fractures, and other adverse events.

Non-pharmacological approaches, such as cognitive behavioural therapy for insomnia (CBT-i), can improve sleep quality and reduce the harms associated with sedatives.

What drives sedative prescribing?
System, clinician, and patient factors all contribute to the barriers of implementing non-pharmacological therapy as a first-line treatment for insomnia. Time constraints or patients less likely to adopt recommended non-pharmacological therapies may lead to sedative prescribing.

How should practice change?
Soong and an international group of clinician and patient coauthors recommend a detailed evaluation of the patient’s sleep history and associated symptoms to diagnose chronic insomnia. In patients with chronic insomnia, offer CBT-i as first-line therapy rather than prescribing or continuing sedatives. Soong and colleagues highlight the importance of initiating conversations about deprescribing sedatives with patients, families, and caregivers to determine an appropriate treatment plan.