Sunday, December 02, 2012

Sleeping Pills May Shorten Life

This study found an association between taking sleeping pills and dying early. There was also an increased risk for cancer with heavy use:

Hypnotics' Association With Mortality Or Cancer: A Matched Cohort Study, British Medical Journal, Feb 2012

It wasn't a small study:
"Subjects (mean age 54 years) were 10 529 patients who received hypnotic prescriptions and 23 676 matched controls with no hypnotic prescriptions, followed for an average of 2.5 years."
Hypnotics are drugs whose primary function is to induce sleep. They include the benzodiazapines [diazepam (Valium), alprazolam (Xanax), lorazepam (Aivan)] and non-benzodiazepines [zolpidem (Ambien), eszopiclone (Lunesta) and zaleplon (Sonata)].

Sophie Ramsey at BMJ wrote a nice summary:

Prescription Sleeping Pills May Raise The Risk Of An Early Death
"What’s particularly notable about these findings is that there was no level of sleeping pill use that wasn’t linked to a higher risk of dying during the study."
Indeed, just a couple pills a year raised risk:
"Compared with people prescribed no sleeping pills, those prescribed one to 18 pills in a year were over 3.5 times more likely to die during the study. Those prescribed 18 to 132 pills in a year had more than four times the risk, and those prescribed more than 132 pills had more than five times the risk."
"The researchers did a good job of taking into account many other factors that might have increased people’s risk, including their age, whether they smoked, their body mass index (BMI), and whether they had other health conditions, including heart problems, diabetes, lung problems, dementia, and kidney disease."
There's a terrible catch-22 here. Not sleeping raises the risk for diabetes, heart disease, cancer, and accidents. Now, taking sleeping pills is being linked to at least some of these conditions. And insomnia appears to be a silent epidemic; Americans filled some 60 million prescriptions for sleeping pills last year. The sleep hygiene guideposts like reducing caffeine, going to bed at regular times, in quiet and darkened environments, getting exercise, eating and drinking in moderation, and of course trying not to think about work or school or money or your ailing spouse/parents/children/friends or the MRI you have scheduled or anything that might disturb sleep, don't seem all that effective.

What could be contributing to all this sleeplessness? Or is shorter sleep duration as one ages just the natural order of things?
The photo is from a NYTs article, F.D.A. Warns of Sleeping Pills’ Strange Effects which is itself disconcerting. "Unusual reactions [ranged] from fairly benign sleepwalking episodes to hallucinations, violent outbursts, nocturnal binge eating and — most troubling of all — driving while asleep. ... In one case, a woman woke up with a paintbrush in her hand, discovering she had painted the front door of her home while asleep."


Angela and Melinda said...

Well, I look at it this way. We all will die from *something*, and I'd rather die well-rested and happy than tired and cranky.

Bix said...

I agree with you about cost vs. benefit.

About these drugs... Who knows if they increase the risk for accidents, cancer, or other chronic conditions. It's fair to say they affect the brain, and not just for sleep because, as Shaun always says, you pull one thread and you change the whole web. They've been shown to affect memory and other cognitive tasks. Still, those may be a fair cost for the benefit of sleep. (Not sleeping causes those same conditions.) But a fractured hip from a fall, I don't know if it's worth it. Cancer isn't worth it. But these are suppositions. And drugs act in concert with other lifestyle choices.

I don't trust pharmaceutical companies. I've seen too many instances where side effects either weren't studied adequately, or were covered up. This Washington Post article says 2/3rds of NEJM articles on drugs are sponsored by pharmaceutical companies, most co-written by their employees.

They gave examples of bias: