Patients who got prescriptions for sleeping pills (hypnotic medications) suffered 4.6 times the rate of death when compared those who received no such prescriptions. The patients were all enrolled in the Geisinger Health System, a large integrated health care provider in rural Pennsylvania that serves 2.5 million people. During the years, 2002 to 2006, when these patients were being treated, zolpidem (Ambien) and temazepam (Restoril) were the hypnotics most frequently prescribed within Geisinger. The study was published in the BMJ yesterday.
The research was performed by epidemiologists at the Scripps Clinic of La Jolla, CA and the Jackson Hole Center for Preventive Medicine of Jackson, WY. The researchers examined medical records of Geisinger patients to ascertain prescriptions of hypnotics and mortality. However, they did not verify that the prescriptions were actually filled and the medications taken. As specified by the case-control research design, each user of sleeping pills (case) was matched with two other non-users (controls) of the same sex, age (±5 yr), and smoking status. The average age of the 10,531 cases and 23,674 controls was 62-64 years.
The comparison demonstrated substantial increases in mortality rate associated with sleeping pill use. Users of fewer than 18 pills/yr nonetheless experienced 3.6 times the rate of death of non-users, while users of 18-132 pills/yr experienced 4.4 times more frequent deaths, and users of more than 132 pills/yr experienced 5.3 times more frequent deaths.
To investigate the possibility that users and non-users differed demographically or in terms of illnesses that could cause death, the investigators analyzed the results with statistical methods to eliminate confounding by age, sex, ethnicity, BMI, smoking and alcohol use. They also compared cases and controls within subgroups (strata) of patients suffering from the same diseases. The results did not change in these comparisons.
In regard to causes of death, the researchers specifically discussed only rates of death from cancer, finding that cancer contributed to some degree to the elevated mortality due to hypnotic drugs. Cancer mortality was not increased among users of <= 18 pills/yr, but it was elevated 1.2-fold to 1.35 fold among users of > 18 pills/yr. The authors speculated about other causes of death associated with sleeping pill use that could possibly contribute to the increases in mortality rate: usage in combination with alcohol or other drugs, associated increases in rates of depression and suicide, depression of respiration and increased sleep apnea, increases in falls and motor vehicle accidents, more frequent regurgitation of stomach contents, and other causes, as well.
The effect of hypnotic drugs in elevating death rates was most dramatic among older patients: People 65-75 years old who used sleeping pills experienced a 9% decline in survival among those followed up to 5 years, and users older than 75 years experienced a 17% decline. In conclusion, the authors noted, Geisinger patient data suggests that in 2010, perhaps a third to a half million excess deaths associated with sleeping pill use may have occurred in the United States.
Until I read this study today, I had thought that minimal to moderate use of sleeping pills, which does not result in dependence, causes little harm. Given that chronic insomnia has been associated with increases in mortality, I even assumed that sleeping pill use might possibly be beneficial. The present report, however, suggests otherwise. It appears that sleeplessness, when it is frequent or chronic, ought to be ameliorated with a behavioral strategy rather than a pharmcological one. Here are some suggestions for improving sleep from the Mayo Clinic.