Summary: People who frequently take sleeping pills are 79% more likely to develop dementia than those who never use them for rest.
A new study shows that sleeping pills increase the risk of dementia in white people. But the type and amount of medication may be factors explaining the higher risk.
It follows previous work which shows that black people have a higher likelihood than white people of developing Alzheimer’s disease, the most common type of dementia, and that they have risk factors and manifestations of different disease.
The corrected final draft of the study is published in the Alzheimer’s Disease Journal is Jan 31, 2023.
In the study, approximately 3,000 elderly people without dementia, who lived outside nursing homes, were enrolled in the Health, Aging and Body Composition Study and followed for an average 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 sleeping pills were 79% more likely to develop dementia than those who “never” or “rarely” used them. Among black participants – whose use of sleep aids was significantly lower – frequent users had a similar likelihood of developing dementia as those who abstained or rarely used the drugs.
High-income blacks may be less likely to get dementia
“The differences can be attributed to socioeconomic status,” said first author Yue Leng, PhD, of the Department of Psychiatry and Behavioral Sciences at UCSF and the Weill Institute for Neuroscience.
“Black participants who have access to sleeping pills might be a select group with high socioeconomic status and, therefore, greater cognitive reserve, making them less susceptible to dementia.
“It’s also possible that some sleeping pills have been associated with a higher risk of dementia than others.”
The researchers found that whites, at 7.7%, were three times more likely than blacks, at 2.7%, to take sleeping pills often, five to 15 times a month, or almost always, 16 times per month every day. Whites were almost twice as likely to use benzodiazepines, such as Halcion, Dalmane and Restoril, prescribed for chronic insomnia.
Whites were also 10 times more likely to take trazodone, an antidepressant known by the trade names Desyrel and Oleptro, which can also be prescribed as a sleep aid. And they were more than seven times more likely to take “Z-drugs,” such as Ambien, a so-called sedative-hypnotic.
While a future study may offer some insight into the cognitive risks or benefits of sleeping pills and the role race may play, patients with sleep disorders should be hesitant before considering medication, Leng said.
“The first step is to determine what kind of sleep problems patients are facing. A sleep test may be needed if sleep apnea is a possibility,” she said. “If insomnia is diagnosed, 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.
Authors: The lead author is Kristine Yaffe, MD, of the departments of Psychiatry and Behavioral Sciences, Neurology, and Epidemiology at UCSF. Co-author is Katie L. Stone, PhD, Department of Research Institute, California Pacific Medical Center, San Francisco.
Funding and Disclosures: The research was supported by the UCSF Claude D. Pepper Older Americans Independence Center, funded by the National Institute on Aging, P30 AG044281. Dr. Yue Leng is supported by the National Institute on Aging (NIA), R00 AG056598. Authors’ statements are available online.
About this news about neuropharmacology and dementia research
Author: Suzanne Leigh
Contact: Suzanne Leigh – UCSF
Picture: Image is in public domain
Original research: Access closed.
“Racial Differences in the Association Between Sleeping Pill Use and Dementia Risk” by Yue Leng et al. Alzheimer’s Disease Journal
Racial differences in the association between sleeping pill use and dementia risk
Background: The effect of sleeping pills on cognition in the elderly is controversial, possibly dependent on sleep quality, and may differ by race. Objective: To determine the longitudinal association between sleeping pill use and onset dementia over 15 years, and to determine whether the association is independent of nocturnal sleep disturbance and whether it differs by race.
Methods : We examined 3068 community-dwelling older adults (aged 74.1 ± 2.9 years, 41.7% black, 51.5% female) without dementia. Use of sleeping pills was recorded three times by asking “Do you take sleeping pills or other medications to help you sleep?” with response options: “Never (0)”, “Rarely (≤1/month)”, “Sometimes (2–4/month)”, “Often (5–15/month)”, or “Almost always (16 –30/month)”. Incident dementia was defined using hospitalization records, dementia medication prescription, or clinically significant decline in global cognition.
Results: 138 (7.71%) of whites and 34 (2.66%) of blacks reported taking sleeping pills “often or almost always”. Whites were almost twice as likely to take all prescription hypnotics. 617 participants developed dementia during follow-up. After adjusting for all covariates, participants who reported taking sleeping pills ≥5/month versus ≤1/month were significantly more likely to develop dementia, and the association was observed only in whites (HR=1 .79, 1.21-2.66) but not in blacks (HR=0.84, 0.38–1.83); p for interaction = 0.048. Additional adjustment for nocturnal sleep did not significantly change the results. The association was similar for the cumulative frequency of sleeping pill use and held after the introduction of a 3-year lag.
Conclusion: Frequent use of sleeping pills was associated with an increased risk of dementia in older Caucasians. Further research is needed to determine the underlying mechanisms.