A recent British Medical Journal article featured this stunning statistic: A prescription for just a few sleeping pills annually was associated with a risk of dying—from any cause—that was 3.6 times higher than for patients without a sleeping-pill prescription.
That rate actually jumped to 5.32 times if more than 152 doses per year were prescribed. Rates for cancer were also significantly increased for people on such hypnotic medications.
Naturally, doctors received numerous phone calls from panicked patients.
The authors of the article estimate that in 2010, hypnotics may have been associated with 320,000 to 507,000 excess deaths in the United States alone. They came to this conclusion by combing through more than 10,000 records of people who were given at least one prescription for a hypnotic and looking at mortality rates over four years compared to matched controls who didn’t have a prescription for hypnotics. The authors were careful to note that association does not imply causality.
This class of medications (nonbenzodiazepines) is given out routinely by physicians despite only lukewarm benefits shown in data submitted to the Food and Drug Administration for approval. None has been tested for long-term use so far.
It’s tempting to interpret this study as implying that sleeping pills can kill people. However, it’s important to realize that there are also numerous studies showing that people with sleep problems are known to have a higher risk of dying from various causes, whether or not they take hypnotic medications.
For example, people with insomnia have higher rates of depression, suicide and cancer. In addition, a significant number of insomniacs on sleeping pills have obstructive sleep apnea, and untreated obstructive sleep apnea can increase a person’s risk of car accidents, heart attack and stroke. Finally, having an insomnia diagnosis is a strong predictor of developing depression later in life.
It’s likely that the risk of dying is already elevated in people with sleep problems, and those who are given sleeping pills are also found to have higher mortality rates. This could, of course, be a classic case of mere coincidence rather than fact. To determine more accurately what causes what, we would have to look at mortality in a large prospective study of people with insomnia and randomize who is to be given sleeping pills versus a placebo.
But this study does underline the huge public health burden of sleep problems in this country. Unfortunately, too many sleeping pills are prescribed when there is a nonpharmacological treatment option: cognitive behavioral therapy for insomnia, or CBT-i. CBT-i has been shown to work just as well as prescription medications, and proves much better in the long term.
So what can you do if you’re concerned about using sleeping pills and are thinking of quitting? If you’re an occasional sleeping-pill user, seek help from your doctor before stopping. If you’re a regular user, especially if you take antidepressants or benzodiazepine-class medications (for example, Valium or Xanax), you should never stop cold turkey. In such cases, your doctor may suggest beginning cognitive behavior therapy with a behavioral sleep physician who will likely work to wean you slowly off sleeping pills. The behavioral sleep doctor will also look for and treat common coexisting conditions such as restless leg syndrome, TMJ or obstructive sleep apnea.