Masked Taper + CBT-I Helps Patients Rethink Sleep Med Needs, with Constance Fung, MD

At SLEEP 2025, HCPLive sat down with Constance Fung, MD, MSHS, from the David Geffen School of Medicine at UCLA, to discuss her late-breaker, “Impact of Benzodiazepine Receptor Agonist Masked Tapering Combined with Augmented CBTI on Daytime Sleepiness and Patient-Reported Sleep Quality.” During the interview, Fung shared how these findings inform deprescribing practices or guideline development for long-term benzodiazepine (BZRA) users with insomnia.

“We're really excited about the prospects of further implementing a masked tapering approach with augmented CPT-I,” Fung said.

Fung and colleagues created a Masked Taper plus cognitive behavioral therapy-augmented program (MTcap) to minimize placebo effects and boost discontinuation. A multi-site trial compared 8 weeks of MTcap with standard, gradual tapering in 188 adults aged ≥ 55 years (mean age, 69.2 years; 34.6%) female) who were on alprazolam, lorazepam, temazepam, or zolpidem for ≥ 2 nights per week and for ≥ 3 months. On average, participants used a BZRA 5.9 days a week.

In the study, MTcap resulted in greater BZRA discontinuation 6 months after treatment (73.4%) compared with standard tapering (58.6%). Insomnia severity improved for both arms, with baseline Epworth Sleepiness Scale scores increasing from 6.32 and 6.21 at baseline for MTcap and standard taper, respectively, to 3.98 and 3.92 at 1 week and 4.54 and 3.91at 6 months. Pittsburgh Sleep Quality index scores also showed improvements from baseline to week 1 and month 6 in both arms.

“I think one of the key elements of the masked tapering program was [that] we had this diary, and we'd ask people, what do you think you were taking on a [nightly] basis, compared to your baseline dose,” Fung said. “We're getting them to challenge their thoughts about their medication.”

Fung said she wants patients to ask themselves, “Is this pill really doing something for me?” After patients finish a MTcap program, they should recognize they are not sleeping well and maybe need a sleeping pill.

“I want them to be challenging that thought,” Fung said. “We'll need to do more analyses to try to get a better picture of exactly what was going on, but I really think that that is one of the reasons why the discontinuation rates were sustained long term.”

Fung has no relevant reported disclosures.

References

Ereso J, Alessi C, Martin J. Impact of Benzodiazepine Receptor Agonist Masked Tapering Combined with Augmented CBTI on Daytime Sleepiness and Patient-Reported Sleep Quality. Late breaker was presented at SLEEP 2025 the 39th annual meeting of the Associated Professional Sleep Societies, from June 8 – 11, 2025 in Seattle.