Which of the following is not a long-term risk of benzodiazepine use?

• A. Dependence
• B. Tolerance
• C. Improved REM sleep
• D. Cognitive impairment

Answer: (C)

Long-term benzodiazepine use carries several well-established risks because these drugs alter brain chemistry over time. They enhance GABA activity, which calms neural activity but can lead to dependence and tolerance; dependence means the body adapts to the drug and withdrawal can occur if it’s stopped, while tolerance means higher doses are needed to achieve the same effect. Cognitive impairment is another common issue with chronic use, affecting memory, attention, and psychomotor function. Sleep-wise, these medications don’t improve true sleep quality over the long term; they tend to blunt REM and slow-wave sleep and can fragment sleep, even if they help with falling asleep at first. So an improvement in REM sleep would not be expected as a long-term risk—in fact, REM sleep is usually reduced with chronic use.