- Sleep disturbances, which are common as people get older, have been associated with an increased risk of all types of dementia.
- According to the CDC, more than 10% of older adults in the United States take medications most days to help them sleep.
- A new study has found that, particularly in white people, frequent use of sleep medications may increase the risk of dementia.
According to the Centers for Disease Control and Prevention (CDC), 8.4% of all adults aged 18 or over regularly take medications to help them sleep. Among older adults, usage is higher, with 11.9% of those aged over 65 using sleep medications.
As we age, we are more likely to experience sleep disorders. These sleep changes may include any of the following:
- Decreased total sleep time at night
- Taking longer to fall asleep
- Falling asleep earlier and waking earlier
- Less slow-wave sleep
- Less rapid-eye-movement (REM) sleep
- Being more prone to disturbance and frequent waking
- Napping during the day.
So, many older people take medications to try and improve the quality of their sleep.
However, for some, these medications may be doing more harm than good, according to new research from the University of California, San Francisco.
The study, published in the Journal of Alzheimer’s Disease, concludes that frequent use of sleep medication increases the risk of dementia, particularly in white people.
“We’ve known for a while that certain sleep medications like benzodiazepines are associated with an increased risk of dementia. This is novel research in a diverse cohort followed longitudinally.”
— Dr. Percy Griffin, Alzheimer’s Association director of scientific engagement.
Which sleep medications?
The study looked at the use of several different sleep medications, from over-the-counter antihistamines to prescription drugs such as antidepressants, antipsychotics, and benzodiazepines.
The researchers recruited a random sample of 3,068 Black and white men and women ages 70–79, none of whom had a dementia diagnosis. The participants were from the Health, Aging, and Body Composition (Health ABC) study in Memphis, Tennessee, and Pittsburgh, Pennsylvania.
At the start of the study (1997-98), participants were asked whether they took any medications to help them sleep. Researchers also asked them how many times a month they took these medications: never, rarely (1 or fewer), sometimes (2–4), often (5–15), or almost always (16–30). They were asked the same question in year 3 and year 5.
The researchers verified which medications were being used by asking participants to bring them into the clinic when they visited.
White participants were almost 3 times as likely as black participants to record using sleep medication often or almost always (7.7% vs. 2.7%). They were also more likely to use prescription sleep medications.
Women, both Black and white, were the most likely to use sleep medication frequently.
Racial differences in dementia
The researchers recorded the onset of dementia if a participant fulfilled any of the following criteria:
- hospitalization record indicating dementia as a primary or secondary diagnosis
- prescription for dementia medication
- evidence of a clinically significant decline in global cognitive function (change of at least 1.5 standard deviations on the race-stratified Modified Mini-Mental State examination).
During, on average, 9.2 years of follow-up, 617 people (20%) developed dementia. The hazard ratio (a measure of relative risk) for those in the ‘often or almost always’ sleep medication groups was 1.83 for white participants and 1.32 for Black participants.
The researchers reported that this showed a “robust association” between frequent use of sleep medication and dementia for white participants. They found no link between the occasional use of sleep medications and dementia.
Dr. Griffin suggested why the research did not find a similar association among Black participants:
“Previous studies have shown that there might be racial biases in the prescription of controlled substances. This study and others showed that Blacks are less likely to receive a prescription for a benzodiazepine. Benzodiazepines have been found to have anticholinergic activity, which increases the risk for dementia.”
An association, not a cause
First author of the study, Dr. Yue Leng of the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California cautioned that their findings did not prove that sleep medications cause dementia, telling Medical News Today:
“We need to be careful with implying ‘causality.’ It may not be sleep meds itself that increased the risk of dementia, but frequent sleep [medications] use could be an indicator of something else, e.g. depression, that also contribute to an increased dementia risk.“
How to improve sleep without medication
“Further studies are needed to confirm whether sleep medications themselves are harmful for cognition in older adults or frequent use of sleep medications is an indicator of other factors that link to an increased dementia risk. In general, non-pharmacological sleep interventions (e.g. cognitive behavioral therapy for insomnia) are encouraged as safer options.”
— Dr. Yue Leng
Getting enough quality sleep is essential for physical and mental health. The CDC recommends that adults ages 18–60 get at least 7 hours of sleep a night and advises the following ways to help achieve this:
- Go to bed and get up at the same time each day, including on weekends.
- Ensure your bedroom is quiet, dark, relaxing, and at a comfortable temperature.
- Remove electronic devices — TVs, computers, and phones — from the bedroom.
- Do not eat large meals or have drinks containing caffeine or alcohol before bedtime.
- Do not smoke.
- Take exercise during the day to help you fall asleep more easily at night.
Some people find melatonin supplements helpful, and when used short-term at the right dosage, doctors consider them to be safe.
Research has shown that lack of sleep in middle age may increase dementia risk, so adopting healthy sleep habits is something we should all be doing.
And Dr. Griffin gave the following advice for people concerned about the effect of sleep medications.
“While this [finding] is interesting, it is worth mentioning that these are association studies. More work is needed to find cause and effect. This research should not be cause for alarm, but rather an opportunity for individuals to discuss their medications and sleep hygiene with their doctor,” he said.
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