March 8, 2023
People who often take medications to aid their sleep are at increased risk of developing dementia, according to a new report. The study found that older white adults who “often” or “almost always” took a prescription sleeping pill at night to help get a better night’s sleep were much more likely to develop dementia than those who “rarely” or “never” used such medications. Older Black adults who often took sleeping pills did not show the same increase in dementia risk, though in the study, Black seniors were far less likely to be frequent users of prescription sleep medicines than whites of the same age.
For the study, researchers at the University of California, San Francisco, looked at 3,068 seniors whose average age was 74; 58 percent were white, and 42 percent were Black. None had Alzheimer’s disease or other forms of dementia at the start of the study, and none lived in a nursing home.
The researchers also recorded how often they took prescription sleeping pills. Almost 8 percent of the white participants took sleep medications “often” (five to 15 nights a month) or “almost always” (16 times a month to every night), compared to fewer than 3 percent of the Black participants.
The investigators tracked them for an average of nine years. During that time, about 20 percent of the study participants had developed Alzheimer’s disease or other forms of dementia.
The researchers found that white adults who took sleeping pills “often” or “almost always” had a 79 percent higher risk of developing dementia than those who “never” or “rarely” took them. Black adults who frequently took sleeping pills did not have a higher dementia risk than those who occasionally took them. The findings were published in the Journal of Alzheimer’s Disease.
There were notable differences between white and Black adults in sleeping pill use. Compared to the older Black adults, white seniors were almost twice as likely to use benzodiazepine drugs like Halcion, Dalmane or Restoril. White were also more than seven times as likely to take another type of sedative-hypnotic, so-called “Z-drugs” like Ambien, and 10 times as likely to take trazodone, an antidepressant that is often prescribed to aid sleep.
The findings build on earlier research showing how sound, restorative sleep may help gird the brain against the ravages of Alzheimer’s disease. Healthy older adults who sleep soundly tend to have less buildup of beta-amyloid in the brain. Deep sleep appears to act as a kind of cleaning system, ridding the brain of toxic debris. Other studies have shown that men and women who slept less than six hours a night in their 50s and 60s were at increased risk of developing dementia when they were older. Similarly, sleep apnea, a common disorder in which people stop breathing for short periods during the night, has been linked to memory decline and dementia.
Sleep problems generally increase with advancing age. While many people turn to sleeping pills, such drugs may disrupt our natural sleep architecture, which alternates between five stages of sleep during each sleep cycle. Importantly, insomnia medications do not fully induce deep sleep, which is the most restorative one, and may in fact interfere with our natural circadian rhythms, the roughly 24-hour daily cycle that regulates our sleep and wakefulness.
Study author Yue Leng of the UCSF Department of Psychiatry and Behavioral Sciences noted that people with sleep troubles should avoid the chronic use of prescription drugs for sleep if possible. “The first step is to determine what kind of sleep issues patients are dealing with. A sleep test may be required if sleep apnea is a possibility,” she said. “If insomnia is diagnosed, cognitive behavioral therapy for insomnia, or CBT-I, is the first-line treatment.” CBT teaches people to challenge negative thoughts at bedtime with positive thoughts that induce relaxation. “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,” Dr. Leng continued.
By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Marc Flajolet, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.
Source: Yue Leng, Katie Stone, Kristine Yaffe: Race Differences in the Association Between Sleep Medication Use and Risk of Dementia. Journal of Alzheimer’s Disease, January 31, 2023