Do Prescription Sleep Medicines Even Work?
An estimated 9 million Americans turn to prescription pills when they can't sleep, but a new study of middle-aged women finds taking the drugs for a year or longer may do little good.
Comparing a group of about 200 women who were medicated for sleep problems with over 400 women who had sleeping problems but did not take medication, researchers from Brigham and Women's Hospital in Boston found that sleep meds don't seem to be beneficial for long-term use. After one or two years on sleep medications, the women in the medicated group did not sleep any better or longer than those who weren't medicated.
"The simple conclusion is that long-term use of sleep medications does not have a clear benefit with respect to chronic sleep problems," said study author Dr. Daniel Solomon, a rheumatologist and epidemiologist at Brigham and Women's.
Although Solomon typically does not focus on issues related to sleep, he was inspired by years of seeing patients who struggle with insomnia. "Usually, I might give a patient a week of medicine for sleep, and sometimes they end up coming back with long-term use, and they're still complaining of sleep issues," he noted.
The findings stemmed from a U.S. National Institutes of Health database that has followed thousands of women to look at how middle age and menopause affect their mental and physical health.
Menopause, when women stop producing certain female hormones and cease to have a monthly period, is well known for causing sleeplessness. Many women experience sleep problems during the years leading up to menopause and into menopause itself.
Solomon's research team identified women in this database who reported sleep problems, such as waking up too early and difficulty falling asleep and staying asleep.
"All the women in our study had reported sleep disturbances. Some of them started a medicine and some did not, and then we followed them longitudinally one year later and two years later," Solomon said. "We asked them about their regular medication use at each annual visit, and we also asked them about sleep disturbances using a well-described sleep disturbance scale."
Since the study primarily consists of yearly check-ins with the participants, it can only show how these medications worked over the long term. However, clinical trials support that for a short time, these drugs do help people sleep.
"There are good, randomized controlled trials that say that sleep medications help over a few weeks or months," Solomon said. "But, it turns out that about 35% to 40% of people who start on them are using them a year later. So the typical way that they're used - i.e., chronic - hasn't been well studied in trials."
The new report was published online May 11 in the journal BMJ Open.
Commonly prescribed sleep drugs include benzodiazepines and "Z-drugs" such as zolpidem (Ambien) and eszopiclone (Lunesta), some of which are intended to promote sleepiness while others are primarily used to calm anxiety.
These medicines are thought to work by altering levels of brain chemicals, called neurotransmitters, that keep you alert during the day and relaxed at night, said Dr. Fariha Abbasi-Feinberg, a sleep medicine specialist and a member of the American Academy of Sleep Medicine's board of directors.
Like most drugs, sleep medications are not without risks. According to Solomon, the most commonly cited concerns are daytime sleepiness and balance issues or falling, particularly when a medicated person gets up in the middle of the night to go to the bathroom. Dependence is an issue, as people can become reliant on their sleeping pills. There may also be a link between sleep medications and memory problems later in life.
"If you're going to use sleep meds, you really have to think about them as short-term or very intermittent meds," Solomon said. "Use them for a week, or a couple of nights here and there. But once you start to use them long-term, it's not as if they're curative for your sleep problems."
While Solomon is not a sleep expert, he said his colleagues in the field recommend "improving sleep hygiene" to remedy ongoing sleep problems.
"It's about making sure you're tired when you go to sleep, you've restricted your caffeine use during the day, and you've restricted use of screens within your bedtime," Solomon said. "Occasional use of sleep medicines or supplements can be useful, but they should not become a chronic treatment for your sleep problems."
When changing sleep habits isn't enough, Abbasi-Feinberg said cognitive behavioral therapy is a potentially effective option for people with insomnia.
"Cognitive behavioral therapy for insomnia helps us reframe our sleep issues," Abbasi-Feinberg said. "It addresses all the thoughts and the behaviors that keep you from sleeping well. It helps you learn new strategies to sleep better, and it can also help with stress reduction, relaxation, schedule management."
Abbasi-Feinberg said that she approaches treating sleep problems like a mystery. "You have to solve the problem and see what's going on with each person and then make a decision for the long term," she said.
The U.S. Centers for Disease Control and Prevention has tips for better sleep.
SOURCES: Daniel Solomon, MD, chief, section of clinical sciences, division of rheumatology, Brigham and Women's Hospital, Boston; Fariha Abbasi-Feinberg, MD, member, board of directors, American Academy of Sleep Medicine, sleep medicine specialist, Millennium Physician Group, Fort Myers, Fla.; BMJ Open, May 11, 2021, online
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