Women, older people and those with lower incomes are more likely to use sleep medications, study finds, despite potential health harms


Millions of Americans say they regularly turn to medication to help them fall asleep or stay asleep, a practice that experts say can be dangerous to their health. A new study found that roughly 8 percent of U.S. adults report taking sleep medication every day or most days, with use more common among women who are older or who have a lower income level.

The brief, released Wednesday by the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics, analyzed data on sleep medication use from more than 30,549 American adults collected from the 2020 National Health Interview Survey.

The researchers defined sleep medication use as taking any medication, whether prescription or over-the-counter, to help sleep most days or every day in the past 30 days.

They found that women were more likely to take sleep medication than men across all age, racial, ethnic, and income groups. Sleep medication use is also highest among older adults, with 11.9 percent of those 65 and older saying they use a sleep aid every night or most nights.

Use of sleep medications decreased as family income increased, from 10% among adults below the federal poverty level to 8.2% among those two or more times the federal poverty level.

“Previous research has found similar associations,” noted study co-author Lindsey Black, a researcher at the National Center for Health Statistics. “This report is useful in documenting the most recent estimates of the prevalence of sleep medication use by adults and confirming that these differences still exist.”

Dr. Nishi Bhopal, a psychiatrist and sleep medicine physician, says these findings are alarming for several reasons.

“Sleep problems are often misdiagnosed in women. I see this in my clinical practice where women can be diagnosed as having insomnia when they actually have sleep apnea, because sleep apnea can manifest much differently in women than in men,” said Bhopal, who is not participated in the new study.

Bhopal also finds it alarming that the most common use of sleep medications is among the elderly, for whom they are not usually recommended.

“Sleeping pills have many side effects and older people are more likely to experience the negative effects of these drugs. These include things like confusion, risk of falling, broken bones, and are even at higher risk of cognitive problems like dementia. So to see the highest rate of use in this population is alarming.

She added that it was “surprising but not surprising” that the use of sleeping pills increased as incomes decreased. Other studies found that people with higher levels of financial stress and debt had more sleep problems and were more likely to be prescribed sleep medications.

Experts say sleeping pills can be useful tools when used as intended. They can be helpful for people going through acute stressors that make sleep difficult, such as divorce, job loss, or grief.

“It’s really important to support patients in the best possible way because insomnia can lead to depression and anxiety,” Bhopal said. “So sleeping pills can be really helpful in that context, but it’s not recommended to use them for more than two weeks.”

Using a sleep medicine every day can lead to problems such as tolerance, where the body physically requires a higher dose of the drug to have an effect, or dependence, where stopping the drug leads to withdrawal symptoms such as seizures. People can also have rebound insomnia, which means they can’t sleep without the medication.

Like lack of sleep itself, consistent use of sleep medications can have serious health consequences.

Research found that older adults who regularly take sedative-hypnotic drugs have a five times higher risk of memory and concentration problems and four times the risk of daytime fatigue and sleepiness, which can lead to poor job performance or a higher risk of car accidents.

Bhopal recommends using sleep medications “for the shortest period of time, in the minimum doses necessary. We will try to use them from time to time for support while we work on good behavioral strategies and addressing other issues that are contributing to their sleep problems,” she said.

These behavioral strategies include maintaining a consistent sleep schedule, exercising regularly, managing stress during the day, and limiting caffeine and alcohol in the evening.

For those who continue to have trouble sleeping, Bhopal says cognitive behavioral therapy for insomnia can help.

“CBTI is the first-line gold standard for the treatment of chronic insomnia. It is much more than sleep hygiene. It actually addresses the issues that perpetuate insomnia and helps people reframe their thinking about their sleep, and also gives them very practical tools to help them restore their natural sleep-wake cycle.

If you consistently have trouble sleeping, talk to your doctor to identify potential root causes.

“I think the main thing is not to be afraid to talk to your doctor about your sleep problems,” Bhopal said, “and ask about cognitive behavioral insomnia, ask about sleep apnea, ask about restless legs syndrome if you think you have any of these conditions.

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