A new study showing a link between sleep medication use and dementia in older adults has people talking. It’s the latest in a growing body of evidence that suggests that older people who regular reach for prescription sleep meds at night may be at an increased risk of developing dementia.
This doesn’t mean if you occasionally take sleep medication (or non-prescription sleep aids like melatonin) that you’re guaranteed to develop dementia, but if you routinely find yourself relying on sleep meds, you may want to talk with your doc about other options. Let’s take a deeper look at what the research says.
What the Most Recent Study Looked At
First, let’s jump into the newly released study. The study, done by researchers with the Department of Psychiatry and Behavioral Sciences at The University of California, San Francisco, was published in late January in The Journal of Alzheimer’s Disease. Researchers found sleep medications increased dementia risk for older adults who are white. The study comes after previous research that suggests Black Americans have a higher risk of developing Alzheimer’s.
The study followed around 3,000 older adults with an average age of 74 for nine years. All of them lived outside nursing homes. Additionally, none had any form of dementia at the beginning of the study. The group was 58 percent white and 42 percent Black. Of the participants, 20 percent developed dementia.
What the Study Found
White individuals who “often” or “almost always” popped a sleeping medication before bed had a 79 percent higher chance of developing dementia in comparison to the participants who rarely or never used sleep medicines. Researchers found the type of medication played a part in risk factors, and so did the amount the individual took.
What about Black individuals who were part of the study? Interestingly, the same connection was not seen among Black participants. “Among Black participants – whose consumption of sleep aids was markedly lower – frequent users had a similar likelihood of developing dementia as those who abstained or rarely used the medications,” the university explained in a press release about the study.
The study also found that the white participants were more likely to take sleep medications than the Black participants. The white study participants were three times more likely to take sleep aids “often,” (defined as five to 15 times per month) or “almost always” (defined as 16 to 30 times per month).
However, it’s important to note that while these findings are interesting, the study was an association study – meaning that it found a relationship between sleep med use and dementia, but it didn’t look at cause and effect.
“This research should not be cause for alarm, but rather an opportunity for individuals to discuss their medications and sleep hygiene with their doctor,” Percy Griffin, Ph.D., director of scientific engagement at the Alzheimer’s Association, says. “This work highlights the need to study modifiable factors and how they influence our risk of dementia as we age.”
Griffin said that is the reason why the Alzheimer’s Association is leading what it calls the US-POINTER study. He said the study looks into how lifestyle factors impact dementia risk, such as how much sleep someone gets.
What Might Explain the Differences in Race?
Yue Leng, the study’s first author, noted in a press release, “Black participants who have access to sleep medications might be a select group with high socioeconomic status and, thus, greater cognitive reserve, making them less susceptible to dementia.”
That’s not the only possibility, though. In that same release, Leng noted that it’s also possible certain sleep medications increased the risk of dementia. Specifically, the white individuals were more likely to use benzodiazepines, which include Halcion, Dalmane and Restoril. They were also 10 times as likely to take trazodone, which is an antidepressant that can be prescribed as a sleep aid. Lastly, when it came to Ambien and other “Z-drugs,” the white individuals were seven times as likely to take them.
Griffin adds that racial biases may also play a role, noting that research shows Black Americans are less likely to receive prescriptions for benzodiazepines. “Benzodiazepines have been found to have anticholinergic activity, which increases the risk for dementia,” he says.
What About Non-Prescription Sleep Aids?
In that same press release above, Leng said melatonin could be a safer option, but there’s still more research to be done on how safe it is to take long term, and cautioned against it as a first-line treatment for insomnia. Instead, like many experts, she recommends cognitive behavioral therapy for insomnia (CBT-I).
What Other Research Says About Sleep Meds and Dementia
This study is one of the newest to find an association between the two, but it’s not the only one.
A 2021 study found a similar link between sleep medications and dementia. Although this study didn’t analyze risk differences among races, it did look into sleep medication use and its connection to dementia over eight years. Researchers found that the routine use of sleeping medication was associated with incident dementia.
Another study, done in 2022, found associations of late-life sleep medication use with incident dementia. In the study, researchers looked at participants taking barbiturates, benzodiazepines, antidepressants, non-benzodiazepine receptor agonists (Z-drugs), or other hypnotics. Participants took the medicines between 2011 and 2013 and were followed through 2019 for incident dementia. The study revealed those who used sleep medications were associated with a 48 percent greater risk of dementia compared to those who didn’t.
That’s not all – a team of researchers from France and Canada linked the use of benzodiazepine medications with an increased risk of Alzheimer’s disease, specially finding the higher the cumulative dose, the higher the risk. During the study, researchers used a database that had drug prescription information.
“People who had taken a benzodiazepine for three consecutive months or less had about the same dementia risk as those who had never taken one. But those who had taken a benzodiazepine for three to six months had a 32 percent greater risk of developing Alzheimer’s, and those taking one for more than six months had an 84 percent greater risk than those who hadn’t taken one,” a write-up on the Harvard Medical School website said.
Benzodiazepines have long been associated with increases in dementia risk across numerous studies, Dr. Michael Nadorff, who is an expert in geriatrics and behavioral sleep medicine, tells Sleepopolis.
“I think this is just one of a line of studies that shows that at least some sleep medications are associated with dementia and cognitive problems,” he says.
One major question that came out of the study, according to Nadorff, is “whether this increase in risk is caused by the benzodiazepine drugs alone, which have been shown to be associated with cognitive deficits, or also by the non-benzodiazepine drugs which are viewed as safer,” he says. “In the interim, while we wait for further research, I think it underlines the importance of helping our patients step off these medications where we can.”
In fact, Nadorff said he appreciates that Leng noted CBT-I should be the first-line treatment for insomnia and said he agrees. He said in general, sleep medications should be used short-term, if needed, ideally only alongside CBT-I. This study is just one showing why sleep medications aren’t an ideal solution, he added.
“Many are not as effective as many people believe them to be, and there are other risks as well such as falls. Because of that, my view is that sleep medications are a short-term solution, and should only be used to get you through a hard stretch to where we can get you the recommended treatment,” he says.
Advice he has for those struggling with sleep issues? Don’t suffer in silence. He recommends working with a sleep specialist to help pinpoint the issue, pointing out it’s not always insomnia.
What Does This Research Mean for Your Overall Risk of Dementia?
Nadorff said while the results don’t look good, it’s important to keep in mind so many factors come into play.
“For instance, we know that sleep problems are associated with a myriad of other health concerns, including dementia,” he said, pointing to a 2016 study that showed insomnia in older adults is associated with dementia.
He went on to explain that it is hard to parse apart what is caused by medications versus insomnia versus other health conditions, stressing that more research is needed, “especially research that parses apart comorbid conditions and other medications to really get to the contribution of all the predictors, including sleep medications.”
Sleepopolis also spoke with Michael A. Grandner, PhD MTR DBSM. He is the director of the Sleep & Health Research Program and director of the Behavior Sleep Medicine Clinic with the University of Arizona College of Medicine. He reminds people that when it comes to the study, these are relative risks.
“These medications can alter the trajectory that a person may be on in terms of dementia risk. Even though sleep problems and sleep medications may increase the likelihood of developing dementia, it’s not an inevitability,” he explains. “Regular poor sleep or frequent use of sleeping pills is more like a regular problematic diet and regular consumption of calorie-dense food. Not everyone who eats a cheeseburger gets diabetes, but the overall pattern of eating can set you on a slightly different course.”