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sleeping pill

A generic term used for one of several different classes of medications used to treat insomnia. These include: Classification: 1) sedative/hypnotics 2) benzodiazepines 3) trazodone 4) ramelteon (Rozerem) [3] Epidemiology: - in 2020, 6.3% of adults took sleep medication every day in the last 30 days [11] - sleep medication use higher in women than men & more frequent with older age [11] Pharmacokinetics: - all start to work in about 30 minutes [3] Complications: 1) increased mortality associated with chronic use a) mortality risk associated with taking a sleeping pill 30 times in the last month is equivalent to smoking 1-2 packs of cigarettes/day b) 1-20 sleeping pills per year sufficient to increase mortality [5] (HR=3.6); HR=6 for > 20 sleeping pills/year [5] 2) amnesia [4] 3) anaphylaxis [4] 4) all increase the risk of falls in the elderly [6] 5) increased risk of hip fractures a) zolpidem (Ambien) b) eszopiclone (Lunesta) c) zaleplon (Sonata) [7] 6) rebound insomnia after discontinuation [6] 7) use in later life increases risk for dementia (RR=1.5) [10] Manangement: - identify the sleeping pill patient is using (melatonin is ok) - screen for depression with PHQ9 as indicated [9] - see insomnia Notes: - long-term sleep medication use not supported by data [8]

Specific

benzodiazepine Indiplon lemborexant (Dayvigo) sedative/hypnotic (tranquilizer) tasimelteon (VEC-162) trazodone (Desyrel, Pragmazone, Oleptro) Z drug

General

pharmacology

References

  1. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  2. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 25-28, 2002
  3. Prescriber's Letter 12(9): 2005 Comparison of Insomnia Treatments Detail-Document#: 210901 (subscription needed) http://www.prescribersletter.com
  4. Prescriber's Letter 14(4): 2007 FDA Requests Label Change for All Sleep Disorder Drug Products Detail-Document#: 230405 (subscription needed) http://www.prescribersletter.com
  5. Kripke DF et al Hypnotics' association with mortality or cancer: a matched cohort study BMJ Open 2012;2:e000850 PMID: 22371848 http://bmjopen.bmj.com/content/2/1/e000850.full
  6. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  7. Berry SD et al Nonbenzodiazepine Sleep Medication Use and Hip Fractures in Nursing Home Residents. JAMA Intern Med. 2013;():1-8 PMID: 23460413 http://archinte.jamanetwork.com/article.aspx?articleid=1657760 - Widera E What's to Blame for Falls and Fractures? Poor Sleep or the Sleeping Medication? JAMA Intern Med. 2013;():1-2 PMID: 23459766 http://archinte.jamanetwork.com/article.aspx?articleid=1657762
  8. Garcia J Long-term Use of Prescription Sleep Meds Unsupported by New Data. Medscape. May 19, 2021 https://www.medscape.com/viewarticle/951472 - Solomon DH, Ruppert K, Habel LA et al Prescription medications for sleep disturbances among midlife women during 2 years of follow-up: a SWAN retrospective cohort study. BMJ Open. 2021 May 11;11(5):e045074 PMID: 33975865 Free PMC article. https://bmjopen.bmj.com/content/11/5/e045074
  9. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  10. Full KM, Pusalavidyasagar S, Palta P et al Associations of late-life sleep medication use with incident dementia in the Atherosclerosis Risk in Communities (ARIC) Study. J Gerontol A Biol Sci Med Sci. 2022, April 13 PMID: 35421897 https://academic.oup.com/biomedgerontology/advance-article-abstract/doi/10.1093/gerona/glac088/6568591
  11. Reuben C, Elgaddal N, Black LI Sleep Medication Use in Adults Aged 18 and Over: United States, 2020 NCHS Data Brief. No. 462. January 2023 https://www.cdc.gov/nchs/data/databriefs/db462.pdf