BALTIMORE—Two-thirds of patients who took prescription sleep medications reported a use duration of longer than one year, with a majority of patients who took such drugs using them for more than five nights per week, according to research presented at the 22nd Annual Meeting of the Associated Professional Sleep Societies. In addition, about 61% of OTC sleep medication users reported use duration of greater than one year, James K. Walsh, PhD, and colleagues found.
The researchers surveyed 1,181 people with insomnia-related claims at a Midwestern health plan and 1,111 randomly selected participants regarding their frequency (nights per week) and duration (number of months or years) of sleep-promoting medication use. The severity of subjects’ insomnia symptoms was determined with use of the Insomnia Severity Index and was classified into four categories—no insomnia, subthreshold, moderate, and severe. Dr. Walsh’s team also examined participants for chronic disease using the Chronic Disease Score, a measure for comorbidity based on medication usage. Psychiatric comorbidities were assessed with use of one of 12 psychiatric diagnostic groupings. To identify the presence of depression, the investigators used the two-question Whooley Depression Screen.
Of the total study population (ages 18 to 80), 1,351 participants did not use any sleep medications, while 941 reported using a sleep aid. The sleep-promoting medication group was subgrouped into those who took OTC medications (n = 267), prescription medications (n = 519), or a combination of OTC and prescription medications (n = 155). No significant age or gender difference was found in participants who used a prescription medication, OTC medication, or both. Medical claims for insomnia were assessed for the year prior to the survey, and self-reported sleep-promoting medication use was ascertained for the four-week period before survey administration.
Frequency and Duration of Sleep-Promoting Medication Use
Dr. Walsh and colleagues found that about 68% of prescription users and 61% of OTC users reported a duration of sleep-promoting medication use of longer than one year, and about 57% of prescription sleep drug users reported taking their medication more than five nights per week. “These data suggest that insomnia is a chronic problem for the majority of these individuals,” the researchers stated.
Approximately half of the participants who used either a prescription or OTC sleep aid took the medication for one to five years (51.9% vs 50.8%). In both the prescription and OTC groups, medication use declined markedly at duration periods of five to 10 years (5.5% vs 3.8%) and more than 10 years (10.3% vs 6.8%). Frequency rates were highest among subjects who used a prescription or OTC drug one to four nights per week; however, there was a substantial difference in frequency between the prescription and OTC groups (33.5% vs 50.2%). Although the lowest proportion of subjects who used a prescription or OTC sleep aid took their medication five to six nights a week (8% vs 10.2%), about 49% of prescription users and 24% of OTC users took their sleep medication every night. Participants who used both OTC and prescription sleep-promoting medications took their prescription medications less often than did the prescription-only group, but they used their OTC medications for a longer duration than did the OTC-only group.
Factors Associated With Sleep Drug Use
Logistic regression results indicated that women were almost twice as likely to use sleep-promoting medications across all sleep-promoting medication groups, after controlling for age, severity, and psychiatric diagnosis. Similarly, older age was significantly linked to greater odds of sleep-promoting medication use.
In the overall sleep-promoting medication and prescription-only groups, increased chronic disease score and a claims-based psychiatric diagnosis were significantly associated with greater odds of sleep-promoting medication use. Compared with those who had no insomnia symptoms, participants with severe insomnia had a 7.4 greater odds of using sleep medications, while those who had moderate or subthreshold insomnia also had a significantly greater likelihood of sleep-promoting medication use (odds ratios, 6.3 and 3.1, respectively); this trend was observed across all sleep-promoting medication groups.
A few factors may limit the results, the authors noted. Reporting errors are common in patient surveys, and claims databases have known restrictions, such as coding errors and enrollment requirements. In addition, medications assumed to be prescribed for the treatment of insomnia might have other uses. Due to privacy issues, Dr. Walsh and coworkers could not determine whether participants who chose not to participate in the study introduced selection bias into the findings.
—Jessica Jannicelli