Optimizing Benzodiazepine Use for Chronic Insomnia: Insights from a Delphi Expert Consensus Study

Introduction: Chronic insomnia is the most prevalent sleep-wake disorder, affecting more than 16% of the general population. Benzodiazepines (BDZs) represent a therapeutic option for this condition, given their rapid action and sleep-maintenance effects. BDZ use remains valid and widespread, even if, in some cases, it has been associated with misuse and tolerance when treatment is protracted. We carried out a Delphi study to reach an expert consensus on the appropriate use of BDZs and potential unclear aspects regarding their management of chronic insomnia, including special populations. Methods: A panel of 33 experts was asked to answer a questionnaire consisting of 35 questions, prepared by a Steering Committee. Items which did not reach a consensus (namely, agreement of more than 66% of responders) in the first in-person round were re-answered by experts in an online second round. Results: Experts emphasized the importance of half-life, formulation, and usage patterns in guiding appropriate prescribing of BDZs. “As‑needed” administration was deemed preferable for specific populations—elderly and individuals with relevant physical comorbidities. However, consensus was not reached regarding the appropriateness of BDZ use for chronic insomnia in women during the first trimester of pregnancy or breastfeeding. The panel also highlighted the need to strengthen clinicians’ training and improve patients’ education. Conclusion: A thorough clinical characterization of each patient with chronic insomnia should remain the cornerstone for guiding BDZ treatment decisions. Enhancing physicians’ training and strengthening patients’ education are essential steps toward optimizing BDZ use.