Sleep Medications Increase your Chances of Dementia, and may Depend of Race

Insomnia is defined as repeated difficulty with sleep initiation, maintenance, consolidation, or quality that occurs despite adequate time and opportunity for sleep and that results in some form of daytime impairment. Specific criteria vary, but common ones include taking longer than 30 minutes to fall asleep, staying asleep for less than 6 hours, waking more than 3 times a night, or experiencing sleep that is chronically nonrestorative or poor in quality. 

Approximately one third of adults report some difficulty falling asleep and/or staying asleep during the previous 12 months, with 17% reporting this problem as a significant one.  From 9-12% experience daytime symptoms, 15% are dissatisfied with their sleep, and 6-10% meet the diagnostic criteria of insomnia syndrome.

Insomnia is more prevalent in women; middle-aged or older adults; shift workers; and patients with medical and psychiatric diseases. In young adults, difficulties of sleep initiation are more common; in middle-aged and older adults, problems of maintaining sleep are more common.

As many as 95% of Americans have reported an episode of insomnia at some point during their lives.

A new study shows that sleep medications increase the risk of dementia in whites. 

In the study, approximately 3,000 older adults without dementia, who lived outside of nursing homes, were enrolled in the Health, Aging and Body Composition study and followed over an average duration of nine years. Their average age was 74; 42% were Black and 58% were white.

During the study, 20% developed dementia. White participants who “often” or “almost always” took sleep medications had a 79% higher chance of developing dementia compared to those who “never” or “rarely” used them. Among Black participants, whose consumption of sleep aids was markedly lower, frequent users had a similar likelihood of developing dementia than those who abstained or rarely used the medications.

Higher-Income Blacks May Be Less Likely to Get Dementia

Black participants who have access to sleep medications might be a select group with high socio-economic status and, thus, greater cognitive reserve, making them less susceptible to dementia.

It’s also possible that some sleep medications were associated with a higher risk of dementia than others.

The researchers found that whites, at 7.7%, were three times as likely as Blacks, at 2.7%, to take sleep medications often, five to 15 times a month, or almost always, 16 times a month daily. Whites were almost twice as likely to use benzodiazepines, like Halcion, Dalmane and Restoril, prescribed for chronic insomnia.

Whites were also 10 times as likely to take trazodone, an antidepressant known by the trade names of Desyrel and Oleptro, that may also be prescribed as a sleep aid. And they were more than seven times as likely to take “Z-drugs,” such as Ambien, a so-called sedative-hypnotic.

While future study may offer clarity on the cognitive risks or rewards of sleep medications and the role that race may play, patients with poor sleep should hesitate before considering medications, according to Leng.

If insomnia is diagnosed, there are many other approaches to treat it , cognitive behavioral therapy for insomnia (CBT-i) is the first-line treatment. If medication is to be used, melatonin might be a safer option, but we need more evidence to understand its long-term impact on health.

SOURCE:

Yue Leng, Katie L. Stone, Kristine Yaffe. Race Differences in the Association Between Sleep Medication Use and Risk of Dementia. Journal of Alzheimer’s Disease, 2023; 91 (3): 1133 DOI: 10.3233/JAD-221006

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