CDC Report Looks at Prescription Sleep Aid Use in the US

Megan Brooks

August 29, 2013

About 4% of adults in the United States — or 8.6 million — report taking prescription sleeping aids, according to a new report released by the Centers for Disease Control and Prevention (CDC).

This analysis is unique because it provides "the first person-based estimates from a nationally representative sample. It gives us a head count of how many adults are actually using prescription sleeping medications and who they are," the report's first author, Yinong Chong, PhD, from the CDC's National Center for Health Statistics, noted in an interview with Medscape Medical News.

Prior studies on use of sleep aids, including sedatives and hypnotics, were largely based on administrative claims data that describe the number of times sleep aid prescriptions are filled rather than how many people have actually used them, she explained.

"We included all the primary FDA [Food and Drug Administration]-approved drugs specifically designed to address sleeping problems and we also included 4 major antidepressant drugs (amitriptyline, doxepin, mirtazapine, and trazodone) that are commonly prescribed for depression and depression-related sleeping problems," Dr. Chong said.

Use Increases With Age, Higher in Women

The percentage of adults using a prescription sleep aid increased with age; the rate was lowest among adults 20 and 39 years at about 2%, increased to 6% in those aged 50 to 59, and reached 7% among those aged 80 and older. More women than men used prescription sleep aids (5.0% vs 3.1%).

Non-Hispanic white adults (4.7%) were more apt to use sleep aids than non-Hispanic black (2.5%) and Mexican-American (2.0%) adults.

Use of prescription sleep aids also rose with high education level: Three percent of adults with less than a high school education reported using sleep aids compared with 3.9% of those with a high school diploma and 4.4% of those with more than a high school education.

More than 16% of adults who reported being diagnosed with a sleep disorder used a sleep aid in the prior month, a rate 5 times higher than that among adults who did not report that diagnosis. About 13% of adults who told their doctor they had trouble sleeping reported sleep aid use, nearly 12 times higher than the percentage of those who didn't report any sleep trouble.

The findings are based on home interviews with US adults aged 20 and older participating in the National Health and Nutrition Examination Survey, 2005–2010.

"This CDC analysis confirms that the rate of prescription sleep aid use is lower than the general prevalence of insomnia," Safwan Badr, MD, president of the American Academy of Sleep Medicine (AASM), said in a statement. Estimates are that up to 50% of Americans have insomnia, yet, according to these data, only 4% use sleep aids for it, he explained in an interview with Medscape Medical News.

"I had expected that the actual use would be higher because the data on prescription sleep aid refills would suggest that it's higher," Dr. Badr said.

However, "like every dataset, you could make several inferences," he explained. "One could say that given the high prevalence of insomnia, some patients who need sleep aids aren't getting them. Or you could say there is an increase use in nonpharmacologic treatment to improve sleep quality and treat insomnia, which is what I would hope. These both are possibilities. A third one is that insomnia may not be recognized as much as it should be as a clinical problem."

Ask About Sleep Problems

Dr. Badr emphasized that addressing insomnia starts by looking at the underlying cause. "Is there another clinical condition causing it? Or, as we see in a large number of patients, it may be psychophysiologic, meaning people aren't following proper sleep hygiene: They are watching TV in bed, drinking caffeinated beverages late, or getting electronic visual stimulation from computers and smart phones late in the night."

Dr. Badr thinks physicians "need to be inquiring more about sleep and giving advice related to improving sleep hygiene to their patients. A good number of patients with sleep problems will respond very favorably to simple basic common sense measures that improve sleep. If not, there are drugs that are effective, if used wisely, under a physician's supervision. Every drug has its set of indications and set of risks. Some patients with significant sleep problems will benefit from evaluation by a sleep specialist," he added.

For physicians, the AASM offers the comprehensive "Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults." For patients, the AASM offers "Ten Safety Tips for Taking Sleeping Pills for Insomnia."

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