A new study shows that perimenopausal women use prescription sleep medications for long periods of time, although there is no evidence of efficacy.
“Although there is good data from [randomized, controlled trials] that these drugs improve short-term sleep disorders, “few studies have examined whether they provide long-term benefits,” said the authors of the paper, which was published at BMJ Open.
“The current observational study does not support the use of long-term sleep medications, as there were no self-reported differences at 1 or 2 years of follow-up compared to sleep medication users with those who did not they use them, ”said author Daniel H. Solomon, MD, MPH, of Boston’s Brigham and Women’s Hospital, and his colleagues wrote.
The women included in the analysis were extracted from the Nationwide Women’s Health Study (SWAN), an ongoing multicenter longitudinal study that examined women during the menopausal transition. The mean age of the women included in the cohort was 49.5 years and approximately half were white. All women reported that sleep disorders at least 3 nights a week for an interval of 2 weeks. At follow-up, women were asked to use a Likert scale to assess three aspects of sleep: difficulty starting sleep, waking frequently, and waking up early. On the scale, 1 represented no difficulty on any night, 3 represented having difficulty between 1 and 2 nights a week, and 5 represented having difficulty between 5 and 7 nights a week.
Women who already used prescription sleeping pills during the initial visit were excluded from the study. Medications used included benzodiazepines, selective BZD receptor agonists, and other hypnotics.
During the 21-year follow-up of the SWAN study (1995-2016), Solomon and colleagues identified 238 women who used sleep medications and compared them to a cohort of 447 drug uses that did not match the propensity score. Overall, the 685 women included were similar in characteristics to each other, as well as the other potentially eligible women not included in the analysis.
Comparison of sleep disturbance patterns
At first, sleep disorder patterns were similar between the two groups. Among drug users, the mean score for difficulty initiating sleep was 2.7 (95% confidence interval, 2.5-2.9), often waking up 3.8 (95 IC). %, 3.6-3.9) and awakening 2.9 (95% CI, 2.7-3.1). Among non-users, baseline scores were 2.6 (95% CI, 2.5–2.7), 3.7 (95% CI, 3.6–3.8), and 2.7 (95). % CI, 2.5-2.8), respectively. After one year, there were no statistically significant differences in scores between the two groups. The average ratings of drug users were 2.6 (95% CI, 2.3-2.8) for difficulty initiating sleep, 3.8 (95% CI, 3.6-4.0) to wake up frequently and 2.8 (95% CI, 2.6-3.0) to wake up early.
The average ratings among non-users were 2.3 (95% CI, 2.2-2.4), 3.5 (95% CI, 3.3-3.6) and 2.5 (95% CI, 2.3-2.6), respectively.
After 2 years, there were still no statistically significant reductions in sleep disturbances among those taking prescription sleep medications, compared with those not taking medications.
The researchers noted that approximately half of the women in this cohort were current or former tobacco users and that 20% were moderate to heavy alcohol users.
More work is needed, not more medication
The study authors acknowledged the limitations of an observational study and noted that because participants only reported the use of medications and sleep disorders on annual visits, they did not know whether the use of patients’ medication was intermittent or of some temporary outcome. In addition, the authors noted that those classified as “non-users” may have been using over-the-counter medications.
“Research should consider detailed usage patterns, daily or weekly, with frequent outcome data,” Solomon said in an interview. “While our data shed new light on chronic use, we only had data collected annually; daily or weekly data would provide more granular information.”
Regarding prescribing practices, Solomon said that “short-term intermittent use may be helpful, but use these agents in moderation” and “educate patients that regular chronic use of sleeping pills is not associated. with the improvement of sleep disorders “.
Commenting on the study, Andrea Matsumura, MD, a sleep specialist at the Oregon Clinic in Portland, echoed this sentiment: “When someone says they have trouble sleeping, that’s the tip of the iceberg and you need a assessment to determine if someone has a breathing disorder, a circadian disorder, a life situation, or a type of insomnia that is causing the disorder insomnia. “
“I think this study supports what we should all know,” Matsumura concluded. “Sleeping aids are not intended to be used long-term” and should not be used for more than two weeks if no more work is needed.
Funding for this study was provided through a grant from the National Institutes of Health. Solomon has received salary grants from research grants at Brigham and Women’s Hospital for work unrelated to AbbVie, Amgen, Corona, Genentech and Pfizer. The other authors and Matsumura have not reported any relevant financial relationships.
This article originally appeared on MDedge.com, which is part of the Medscape professional network.