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Sleeping Pill Use Linked to Early Death

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Researchers analyzing the electronic health records of more than 30,000 patients have found that those taking popular sleeping pills such as temazepam (Restoril), zolpidem (Ambien), eszopiclone (Lunesta) and zaleplon (Sonata) were significantly more likely to die during the two and a half years of follow-up.

The records of 10,529 patients who got sleeping pill prescriptions between 2002 and 2007 were matched to those of 23,676 people who got no sleeping pills. The matches took into account gender, age (average was 54 years old), obesity, smoking, health problems diagnosed other than insomnia, ethnicity, alcohol use and marital status. The results were shocking: those taking sleeping pills were about four times (3.6 to 5.6) more likely to die during the follow-up.

People 18 to 55 who took sleeping pills were at greater risk of dying during this time than those aged 65 to 75 not taking sleeping pills. Older people (especially those over 75) and those who took sleeping pills more often were at especially great risk. The research is published in the new journal BMJ Open

The researchers point out that these medications can impair judgment and reaction time and may make driving accidents and falls more likely. They can also exacerbate sleep apnea, which has an effect on blood pressure and heart disease. Zolpidem, moreover, increases acid reflux and is associated with more esophageal damage, cancer and infections.

The investigators also found that people taking sleeping pills were 20 to 35 percent more likely to be diagnosed with cancer during the follow-up. This too is alarming news for the up to 10 percent of American adults who take one of these popular sleep aids. The scientists point out that this study establishes an association and does not demonstrate that sleeping pills cause cancer. They estimate, though, that these medications may have resulted in 320,000 to 507,000 unnecessary deaths in this country in 2010 and note that even 10,000 excess deaths would be too many. They suggest that the limited benefits of prescription sleep aids may well be outweighed by these new data indicating how serious the risks may be.

People who would like to learn more about non-drug approaches to combating insomnia may be interested in our Guide to Getting a Good Night's Sleep.

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28 Comments

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I took zolpidem (Ambien), eszopiclone (Lunesta) and zaleplon (Sonata) for close to 10 years and I think those are some very scarey meds to start with! I tel everyone to take these medications with great caution!

Hi,

Well, this is rather disturbing news. Can you explain what "during the two and a half years of follow-up" means? Does this imply that they were not taking the sleeping pills during the follow-up, or were they still taking sleeping pills? Is there any other explanation for the increase in cancer other than acid reflux?

Thanks

PEOPLE'S PHARMACY RESPONSE: They were taking sleeping pills, at least some of the time, during those two and a half years. We don't have a good explanation for the 20 to 30% increase in cancer risk.

This article makes me wonder about products like Tylenol and Advil PM.
My husband takes those a few times a week every week. He appears to have no residual effects. I, on the other hand cannot wake up the next day if I take one. SO I almost never take anything but hot milk. Is there a possible link in the PM products as well as "sleeping pills"?

Thank you very much. I learn so much from you all's newsletter every week. You both do a wondeful service.

God bless,

Bonnie

Did the researchers consider stress level? I would wonder if perhaps a significant percentage of folks taking medications for sleep were also experiencing substantial stress, with sleep disrupted for that reason. I think that the risk of cancer increases with substantial stress. Did the researchers miss the boat with respect to considering a potentially important intervening variable?

What about people taking 50 - 150 mg Trazodone?
Any info about Trazodone? Any other side-effects to watch out for?

PEOPLE'S PHARMACY RESPONSE: Trazodone was not one of the pills included in the study. It is always prudent to be informed about side effects. This is from the physicians' prescribing information:

"All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases.

The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric."

'Other indications' includes helping you sleep.There is a fairly long list of side effects, including drowsiness (a benefit in your case), dizziness, dry mouth, low blood pressure, fatigue, blurred vision, nausea or vomiting, headache, nervousness, and (disconcertingly) insomnia.

does this include such sleep aids such as trazadone? please inform...thanks!

PEOPLE'S PHARMACY RESPONSE: It did not include trazodone.

the study doesn't say how often they take the pills. nightly? once in a while when traveling or ???

PEOPLE'S PHARMACY RESPONSE: The most alarming part of this study is that even people who only took the pills occasionally still ran some risk.

I had serious problems when taking Zolpidem to sleep prior to and during a long grueling trip. Even with the sleep aid, I could only sleep 4-5 hrs. per night and was sleep deprived for 3-4 weeks. I could not think, concentrate, or remember anything. During this time I had a throat infection for 4 weeks. Six weeks after returning home, I experienced idiopathic sudden sensorial hearing loss. I do not know if this was related.

I will not take sleeping pills again. I now take Melatonin, which is also prescribed for the hearing loss and related tinnitis. I finally am sleeping well.

Does this study apply to OTC sleeping pills such as Tylenol PM?

PEOPLE'S PHARMACY RESPONSE: No, although diphenhydramine (the PM part) has some other drawbacks, particularly for older people.


HUH.... Well, as a very high-strung person, I do take Ambien if I have to get up early for something; otherwise I'd be awake all night thinking and worrying about it... It would be VERY HELPFUL to know if taking a sleeping pill, say, one time per week would still increase the risk of death pro-rata. It would be even MORE HELPFUL to get a breakdown of the deaths by type. e.g., if you take an Ambien and then "sleep-drive" and get into a fatal accident, that's very different from, say, just dying mysteriously in your sleep one night as a result of ingesting the chemicals specific to sleep meds over a certain span of time. Thank you.

It also might be a question of correlation vs. causation. For instance, I know for a fact that people who tend to be more manicky, unstable, disorganzed (etc.) have a much worse time getting adequate sleep.... and this would be the exact same demographic that might suffer more auto accidents, physical trauma, violence at the hands of others, health-related problems due to poor lifestyle choices, etc. Peoples Pharmacy, what do you think?

PEOPLE'S PHARMACY RESPONSE: The scientists are being very careful to point out this is association, not cause-and-effect. They do have some reasons to believe that sleeping pills could have negative effects, though, and they are calling for someone to do a big placebo-controlled study to answer this question more completely.

I wonder about Ativan for sleep? I have sleep apnea, but can't stand the mask even after 18 months of trying...

PEOPLE'S PHARMACY RESPONSE: Benzodiazepines like Ativan (though not necessarily including Ativan) were no safer in the study than other sleep aids.

I wonder if Melatonin has the same issue. Or, is it safer?

PEOPLE'S PHARMACY RESPONSE: So far as we know, melatonin does not have the same impact. The researcher we spoke with specifically mentioned it as a safer alternative.

I take Ambien-- this report is kind of scary. You would think if was a big enough study & the results were really true they would pull the pills off the market.

Yes, I believe it, but going wihout sleep for weeks, months or more, also leads to death! Sleep is so important that it's worth taking a chance in order to get some! For some of us, there's no other way to consistently get a full night's sleep without them.

I take 50 mg of Trazodone every evening. My doctor assured me that this medication is safe.

I've been taking the Trazodone for sleep for several years. So far still alive and better for having the sleep. Poor sleep causes severe migraines in my case, and I was never a good sleeper. (exercise helps, too. I can cut the dose with daily exercise)
I got over the dry mouth. The only side effect that I notice is that when the dose is up to 150mg/night I am still foggy or tired first thing in the morning. On 100mg/night I do much better.

Thanks for the information.

Ambien completely changed my life. I cannot sleep / function without it. I'll have to take a chance on it's possible consequences. This report will do alot of harm if not true.

Please advise if Silenor-3 mg(doxepin) a relatively new prescription drug for sleep on the market is also considered to be a danger? I take it 3x a week, it also has a dramatic lowering effect on my blood pressure reading-reducing it to safe levels-or is this due to getting a better night's sleep? This med supposed to be non-addictive in such small doses so I felt it is safe. I would greatly appreciate your advice.
Thank you.

How do you find a good brand of melatonin and how much do you take? Some years ago there was lots of publicity surrounding the side effects of melatonin. Both my husband and I have been taking Ambien and we're in our 70's and just can't get a good night's sleep even though active during the day with no naps. We are seriously looking for alternatives.

This study is pretty ridiculous for several reasons:
1. The study only proves a patient being PRESCRIBED a hypnotic increased death. That is a mighty pen. There is no data showing if the prescription was filled at a pharmacy, let alone taken by a patient. Did the patient take 1, 2, 20 pills, who knows? How often did they take them? Maybe they washed it down with Jim beam every night followed by cocaine, nitroglycerine and Xanax.

2. I would bet my life on similar studies showing people getting handed prescriptions for cancer medications also have increased mortality rates because they are sick people.

3. Patients who take sleeping pills have medical problems. Rarely is a hypnotic the only medication taken. Only a small percentage have no comorbid conditions. If you can't sleep because you worry about the next day, you need a medication for anxiety and a sleep aid. Usually they have ssri's or other mental health medications, or maybe they're undergoing chemotherapy. Ssri's warnings say... they can cause depression and suicides. Sometimes people are given medications for sleep that are only approved by the FDA to treat another disease but have a bad side effect that makes people drowsy- even though these medications have never been studied to see what happens to patients only taking them to help them sleep. Everyone on trazadone is testing this for the FDA. It's an old antidepressant and not intended as a sleep medication. These lucky people are also doing the study for the FDA to test its other major side effect. Priapism. I bet these drugs also raise mortality rates. Seroquel is another one.

3. The main side effect of an antidepressant is worsening of depression. Last I heard, depressed people sometimes commit suicide. If you have sleep apnea and take it to help you sleep without an apnea treatment, your apnea can get worse and can kill you in your sleep.

4. What did these people die of? There is no tracking of cause of death. Maybe they got hit by buses, had asthma attacks, or heart attacks. Did they die in their sleep? Who knows? If they were eating or driving around in their sleep then ambien probably did cause their death, if not probably something else. Maybe even natural causes.

5. Who has the highest risk of mortality? Elderly. Who has the most trouble sleeping? Elderly. Is that the pill or your doctors fault that he or she handed you a prescription with the words sleep aid on it. These people' chances of death are way higher already.

This is a very, very reckless study. If people take less sleep aids, I bet mortality goes up again because lack of sleep is proven to cause an increase in heart attacks, high blood pressure, diabetes, depression, anxiety, etc. I can't believe someone actually published this study.

Thanks for your comment Alice, my thoughts exactly. It's easy for someone who doesn't have lifelong sleep problems to suggest not taking Ambien, etc. My thought has always been, the lack of consistent sleep is more likely to be worse than any pill side-effect.

I haven't slept well as long as I can remember Anxiety -ridden as a child I had horrific nightmares. As an adult, I sleep lightly if at all & constantly suffer panic attacks & shortness of breath at bedtime. Read that lack of sleep can lead to all kinds of physical & mental problems. After trauma of a car accident where I sustained permanent injuries to my neck & back, I get almost no sleep between anxiety & chronic daily pain. Suffering vertigo, exhaustion, memory loss & confusion. So far, Lunesta & later, Ambien have helped me immensely. At least I feel sane after a full night's rest & my anxiety is lower when I know I'm actually going to sleep for more than 2-4 hours. So now I have to worry that what's seeming to help me may kill me?

I understand the dilemma that DKV is battling. My only thought is that lack of sleep can also cause death, sometimes involving a horrific accident. Sleep is critical to our survival! I would take my chances with an effective sleep aid before I would walk around and try to function in a stupor due to lack of sleep.
I am not a pill taker but pills do have an effective purpose when you need them. Perhaps DKV could consult a physician and try to find the least harmful way to get the sleep they need and deserve.

Hope this helps,

Bonnie

I have been taking prison (estazolam) for 20 years. I realize I am dependent on them. I have expressed concern to my doctor. However he says that since I have never gone over the prescribed dose and often take less, I needn't worry. I can sleep without them. However I feel anxious and weird the next day. This has led to fear of not taking them. I try to wean off but it's a slow process. Any thoughts on that?

Also other than ambien and acid reflux what is the cancer link? Doesn't make sense. I do have acid reflux but doesn't seem connected to prison and now they say antacids will kill you!! I also take benedryl a lot. I have been told this is fine. What do you think about that? I agree with several commentors....people who have active minds and struggle to turn them off and sleep don't need to ad this fear. There needs to be concrete in depth studies.

I an ashamed to say that I have been taking Ambien fairly regularly at night for almost 20 years. More recently, in October 2011, I started to develop what is called "burning tongue syndrome," accompanied by a metallic taste in my mouth. No doctor here in Sarasota has been able to come up with a remedy to cure my daily ailments.

I also take 3 diffrent heart medications daily (Norvasc, Cozaar and Imdur) for high blood pressure as a result of a heart attack 6 years ago. However, it's this nagging problem involving my mouth that is frankly driving me insane.

My daughter in Chicago suggests that I go to Cleveland Clinic or Mayo to have a team of doctors assess the problem. Anyone out there with similar issues?

Did this study include Lorazepam?

PEOPLE'S PHARMACY RESPONSE: Yes.

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