Everybody loves – and needs – a good night of sleep. Occasional nights of poor rest, for whatever reason, can be tolerated by most, but ongoing insomnia wreaks havoc with our alertness, moods, and day-to-day functioning. Despite being retired and presumably having less to worry about, senior citizens have a well-known tendency to sleep poorly.
This may be from stress related to disease and declining function or it may reflect something innate. For example, levels of the sleep-inducing hormone melatonin reach a low point in old age – though they actually begin to decline in adolescence. Poor sleep is also sometimes associated with obvious daytime anxiety.
Regardless of cause, adults with insomnia frequently go to their doctors with requests for sleep medication, and doctors usually comply. The largest class of anti-anxiety and sleep-inducing medications – as they do both – is called the benzodiazepines (BEN-zo-di-AZ-i-peens). These have been in use for many decades. Only in the last ten years or so have they been somewhat supplanted by newer, non-‘benzo’ medications such as zolpidem and others. These help many people fall asleep but can have side-effects for some such as morning sleepiness and memory problems, particularly for the benzodiazepines.
Now from France comes a large study showing that 32% of seniors taking sleep medications – both benzodiazepines and the newer ones like Ambien – went on to develop dementia, compared with 23% of those not using the drugs. That’s an almost 50% increase in dementia for regular takers of sleep meds. Of note, this was a very carefully controlled study of over a thousand older folks taking medication for sleep versus a similar group sleeping alright on their own. It was reported in the well-regarded British Medical Journal.
The new study is directly in line with three previous but smaller studies. However, there are also two reports in the medical literature that found no increased risk of dementia with the medications. This sort of variability is maddening to doctors and patients alike, but is fairly common in studies of these types. There can be legitimate reasons for the differences – that is, it’s possible that all of the studies are “correct,” at least for the population studied.
Nonetheless, the reports suggesting a link between sleep meds and dementia now outnumber those saying otherwise by two to one, prompting at the least a much heightened sense of caution about the issue. A complicating factor is that many people – not just seniors – end up taking these medications much longer than they are intended for. Although not purposely abusing the drugs, some people can become addicted to them and unable to fall asleep otherwise.
It could well be that chronic use of these drugs is the specific problem. Even the authors of the latest study say that occasional, limited use of sleep aids is unlikely to lead to problems – but this may depend on just how occasional and limited that use really is.
It’s also possible this is a matter of what doctors call “reverse causation.” In this case, it may be that people already biologically destined to develop dementia in their later years happen to show insomnia in the years preceding the arrival of obvious mental decline. In this scenario, insomnia during mid-life or in younger seniors may be a warning sign of eventual dementia, as there is some discussion of this possibility already among sleep doctors.
So, what’s the average, older insomniac to do? Certainly they should consult their doctors and possibly take some sleep medications. However, caution suggests that people look into non-drug approaches to better sleep, which can be found in computer searches of “sleep hygiene”. Furthermore, as much as possible, limiting the use of sleep medications to only the worst bouts of insomnia may be a good way to err on the side of caution.
Sophie Billioti de Gage et al. “Benzodiazepine use and risk of dementia: prospective population based study” BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6231
Guest article by SleepDisorders.com. SleepDisorders.com is an online portal connecting sleep disorder sufferers to a nationwide network of sleep doctors as well as informational articles and a unique Question and Answer system.