Diagnoses of insomnia have been on the rise -- and so has the use of medication to treat this sleep disorder. The popularity of a newer class of drugs -- non-benzodiazepine sedative hypnotics -- has risen dramatically. Drugs included in this group include zolpidem, zaleplon, and eszopiclone, and are sometimes referred to as "Z-meds" or "Z-drugs." Some of the most frequently prescribed sleep medications contain these drugs, including Ambien and Ambien CR, Zolpimist, Intermezzo, Sonata and Lunesta.
There is a great deal we don't yet know about long-term risks and complications of these newer sleep medications. We are also just beginning to get a sense of how frequently they are being used by adults in the U.S. What's more, we know very little about the characteristics and non-sleep health and lifestyle factors that might influence a person's likelihood to use these medicines -- whether by their own prescription, or through sharing medication prescribed for someone else.
These are important questions to pursue. This information can help scientists achieve a deeper, more comprehensive understanding of the risks and effects of the drugs themselves and help clinicians treat insomnia and other sleep disorders safely and responsibly. A recently released study has addressed some of these gaps in knowledge. Researchers at Beth Israel Deaconess Hospital, Massachusetts General Hospital, and Harvard University conducted research to determine the prevalence of medications commonly prescribed for insomnia, and to examine the patterns of sleep medication use among adults in the U.S. They also investigated whether demographic, health, and lifestyle factors might be associated with a greater likelihood of use.
Researchers used data from the National Health and Nutrition Examination Survey (NHANES), an ongoing federal research project that collects and shares data about the health status and habits of children and adults in the U.S. The study used nationally-representative information from more than 32,000 men and women age 20 and older, collected between the years 1999 and 2010. The study identified people who had used medication commonly prescribed for insomnia within the past 30 days. Researchers also extracted details about the types of medication used, characteristics including age, gender, insurance status, and income, as well as health issues among those who'd used medication for sleep in the past month. Their analysis confirms a significant increase in the use of prescription sleep meds -- particularly "Z-meds "-- among American adults. Their results also paint a more detailed picture than we've seen before of the people who are more likely to rely on prescription medications for sleep, including women, older adults, and people who've sought mental health treatment:
- Between 1999 and 2010, rates of prescription sleep medication use rose significantly, from an estimated 2 percent of the population to 3.5 percent. That's more than 6 million adults in the U.S. who in 2010 reported using sleep medicines in the past month.
- The most commonly prescribed drugs were "Z-meds." Among these drugs, zolpidem was by far the most frequently used, comprising 87.5 percent of Z-med use.
- Rates of Z-med use increased by more than 3 times between 1999 and 2010.
Researchers found several characteristics associated with higher rates of use of prescription aids for sleep:
- Women were more likely to use these medications than men. Among the study population, 3.61 percent of women used prescription sleep aids, compared to 2.28 percent of men. Women tend to be at greater risk for insomnia than men. Being female was associated with increased likelihood of prescription sleep aid use.
- Older adults used prescription sleep medication more frequently than younger adults. Among participating adults in age groups 70 and older, rates of sleep medication use ranged from 4-5.3 percent. Increasing age, starting at age 40, was associated with increased likelihood of sleep medication use. Older adults are at greater risk for insomnia, and also may face greater risk for complications from medications to treat sleep problems.
- People who used prescription sleep medications for insomnia tended to have higher incomes. Family incomes exceeding $75,000 per year were associated with increased use of sleep medications.
- People who reported being in worse health used prescription sleep aids more frequently. Reporting health as good, fair or poor (as opposed to excellent or very good) was associated with greater likelihood of using prescription aids for sleep.
- People who reported seeing a mental health professional in the past year were significantly more likely to use prescription sleep medication for insomnia than those who did not seek this assistance. Among the study population, 14.9 percent of people who sought mental health treatment used sleep aids, compared to 2.06 percent of those who did not. Use of mental health services was one of the factors most strongly associated with use of sleep medications for insomnia.
- A majority of people -- 55 percent -- who used commonly prescribed sleep medications for insomnia also used other prescription sedative medications during the same 30-day period. Use of other prescribed sedatives was another of the strongest predictors of use of prescription medication for insomnia.
- 10 percent of participants who reported using a prescription sleep aid also reported using three or more other prescription sedatives in the same 30-day period.
These last findings are particularly troubling, indicating that among the millions of people using sleep medications, there are many who are using multiple medications at once, putting them at greater risk for complications and adverse reactions.
Another detail that jumps out? Researchers found that more than half -- 58.1 percent -- of respondents who said they'd used any type of pill or medication for sleep in the past month did not report using prescription sleep medication. This suggests that for all the millions of people using prescription sleep aids, an even greater number of people are using non-prescription medicines for sleep. Research that explores the frequency and patterns of over-the-counter sleep aid use is scarce, and its time for that to change.
Similar to another recent study on sleep medication use, this current study looks only at prescription medication use in previous 30 days, so there is no way to tell how much of this usage is short-term vs. long-term. Most prescription sleep aids for insomnia are intended for short-term use, to break the cycle of sleeplessness and anxiety about one's ability to fall asleep. We need to see more research that distinguishes between short-term and long-term patterns of use of these drugs.
Still, there is a great deal that's illuminating in these findings. This study provides us with a more detailed picture than we've had previously about the people most likely to rely on prescription sleep aids. This gives us an opportunity to begin to assess the effectiveness of these treatments, and the risks, for these specific groups. The progress achieved here also reinforces just how much more we need to know about these drugs and their long-term effects, so that they can be used safely and appropriately.
Michael J. Breus, PhD
The Sleep Doctor®
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