Long-term use of prescription drugs for insomnia does not appear to improve disrupted sleep in middle-aged women, research published in the online journal suggests. BMJ Open.
There was no difference in the quality or duration of sleep between those who took and did not take these drugs for 1 to 2 years, depending on the results.
Sleep disturbances – difficulty falling asleep and / or staying asleep and waking up early – are common. About 9 million adults in the United States alone say they take prescription drugs to try and get a good night’s sleep.
Poor quality sleep is associated with poor health, including diabetes, high blood pressure, pain, and depression, and various medications are prescribed to cause the eyes to close.
These include benzodiazepines, Z drugs which include zolpidem, zaleplon, and eszopiclone, as well as other agents primarily intended for other conditions (off-label use), such as combating anxiety and the Depression.
Data from clinical trials indicate that many of these drugs work for the short term (up to 6 months), but insomnia can be chronic and many people take these drugs for longer, researchers say.
So they wanted to assess the effectiveness of drugs used to fight long-term insomnia in an ethnically diverse group of middle-aged women who had developed sleep disorders.
The women were all part of the Nationwide Women’s Health Study (SWAN), a long-term, multi-center study looking at the biological and psychosocial changes that occur during menopause. The average age of the women was 49, 5 years and about half were Caucasian.
Sleep disturbances were defined as difficulty falling asleep, waking up frequently and waking up early and rated on a 5-point scale, ranging from no difficulty one night (1) to difficulty for 5 nights or more than the week (5). during an average of 21 years of surveillance.
Sleep disturbances, measured on the rating scale, were compared among those who took and did not take prescription drugs to improve their sleep after 1 and 2 years.
Some 238 women who started using drugs for insomnia during the follow-up period were matched with 447 women who were not taking these drugs.
Both groups of women reported difficulty falling asleep 1 in 3 nights, waking up frequently 2 out of 3 nights, and waking up early 1 in 3 nights of the week. Over 70% of women in both groups reported trouble sleeping at least 3 times per week.
For starters, the sleep disturbance ratings were similar between the two groups of women. Those who took prescription drugs for their sleep problems had mean scores of difficulty falling asleep, waking up frequently, and waking up early of 2.7, 3.8, and 2.8 respectively.
This compares to equivalent scores of 2.6, 3.7, and 2.7, respectively, for those not taking prescription drugs to get a good night’s sleep.
After 1 year, the mean scores among those taking the drugs were 2.6, 3.6, and 2.8, respectively. The equivalent mean scores among those who did not use prescription drugs for their sleep problems were 2.3, 3.5, and 2.5, respectively.
None of the changes over one year were statistically significant, nor did they differ between the two groups. And after 2 years, there was no statistically significant reduction in sleep disturbance among those who took prescription drugs compared to those who did not.
This is an observational study, and as such cannot establish the cause, only the correlation. In addition, about half of the women were current or former smokers and 1 in 5 were moderate to heavy drinkers, which can affect the quality of sleep.
Information gathered on prescription drugs was also collected only during annual or biennial study visits, and there may have been intermittent or non-use periods between visits, the researchers said. There were also no objective measures of sleep quality.
Nevertheless, the researchers conclude: “Sleep disorders are common and their prevalence is increasing. The use of sleeping pills has increased and they are often used over a long period of time, despite the relative lack of evidence of [randomised controlled trials]. “
These drugs may work well in some people with sleep disorders for several years, but the results of this study should give food for thought to prescribing clinicians and patients considering prescription drugs for sleep disorders as they age. average, they add.