Sleep Meds

Loren Bonner

Americans may be surprised to find out that the use of prescription medications for sleep disturbance has declined.

According to a new research study published in the Journal of Clinical Sleep Medicine on October 1, 2022, medications for sleep disturbances and medications approved by FDA for the treatment of insomnia declined over the 5-year study period from 2013 to 2018.

The odds of using medications for sleep disturbance decreased 31% between 2013 and 2018 and, most notably, use of FDA-approved sleep medication declined by 86% for individuals aged 80 years and older.

“The most striking finding was that the age group of people that saw the steepest declines were those over 80 years old,” said lead author Christopher Kaufmann, PhD. “This is significant because a number of clinical guidelines strongly discourage use of these agents in older adults, including the Beers Criteria published by the American Geriatrics Society.”

Kaufmann noted that their research is among the first to show a decline in the use of medications for sleep disturbance.

Results

Previous research indicates that Americans were increasingly taking medications to help with sleep up until the mid-2010s. “This has been surprising because there are general concerns that use of these medications may be linked to adverse effects such as falls, particularly in vulnerable groups like older adults,” said Kaufmann.

Many initiatives over the past few years have been created to help curb over-prescription and encourage judicious use of these sleep agents, according to Kaufmann, who is with the Department of Health Outcomes and Biomedical Informatics at the University of Florida College of Medicine in Gainesville. “We wanted to see if these initiatives worked.”

The research team used data from roughly 29,000 participants included in the 2013–2018 National Health and Nutrition Examination Survey. “A major strength of this study is we used nationally representative data of people in the United States. Our results do not just apply to people in health care settings, but also to those living in the community,” Kaufmann said.

Most past studies, he noted, have relied on prescribing data via claims from public or private health insurance providers or medical record data.Participants were asked to bring in all their prescription bottles used in the prior month. Individuals self-reported duration and reasons for use for their medications.

“We focused on medications that study participants themselves reported to be used for sleep disturbance—in other words, we knew the personal reasons the participant took the medication,” Kaufmann said.

The researchers identified all medication for sleep disturbances: FDA-approved sleep medications and those used off-label for sleep disturbance. Then they examined changes in the prevalence in use of these medications for patients across the study period.

“One noteworthy limitation is [the study] only extends up to 2018, which was prior to the onset of the COVID-19 pandemic,” Kaufmann said. “More research is needed to explore how trends changed in more recent years.”

Theories

Kaufmann said there could be a multitude of reasons behind the decline in sleep medication use among Americans. For instance, there have been several initiatives through the years to discourage use of medications for sleep disturbances. One example, he said, are deprescribing programs where patients are guided through a process of tapering or even discontinuing use.

There have also been efforts to increase availability of behavioral sleep treatments such as Cognitive Behavioral Therapy for Insomnia (CBT-I).

“Many Americans do not have access to CBT-I due to limited number of clinicians trained in delivering this treatment,” Kaufmann said. “Efforts have been made to make these treatments available over the internet via smartphone apps, for example.” ■

Experts warn about giving melatonin to children

Parents are encouraged to speak with a health care professional before giving melatonin or any supplement to children, says a new health advisory from the American Academy of Sleep Medicine (AASM).

Federal data show that the number of U.S. children who unintentionally ingested melatonin supplements increased by 530% from 2012 to 2021. More than 4,000 of the reported ingestions led to a hospital stay, and 287 children required intensive care.

Melatonin is a widely available OTC product that is typically marketed as a sleep aid, and often available as a gummy or chewable tablet for children. However, there is little evidence indicating that its use as a supplement is effective in treating insomnia in healthy children, AASM said. The group noted that melatonin content in supplements can vary widely, with amounts of the substance ranging from less than one-half to more than 4 times the amounts stated on labels. The greatest variability in melatonin content was in chewable tablets. ■