Women, older adults and those with lower income are more likely to use sleep medication, survey finds, despite potential health harms

Millions of Americans say they regularly turn to medications for help falling or staying asleep, a practice that experts say can be dangerous for their health. A new study found that roughly 8% of US adults reported taking sleep medication every day or most days, with use more common among those who are female, who are older or who have a lower income level.

The data brief, released Wednesday by the US Center for Disease Control and Prevention’s National Center for Health Statistics, analyzed sleep medication use data from over 30,549 American adults that was collected by the National Health Interview Survey in 2020.

The researchers defined sleep medication use as taking any medication, whether prescription or over-the-counter, to help fall or stay asleep most days or every day in the past 30 days.

They found that women were more likely to take sleep medication than men across all age, race and ethnicity, and income groups. Sleep medication use was also highest among older adults, with 11.9% of those 65 and over saying they use a sleep aid every night or most nights.

Sleep medication use fell as family income rose, from 10% among adults below the federal poverty level to 8.2% among those making two or more times the federal poverty level.

“Previous research has found similar relationships,” noted study co-author Lindsey Black, a researcher at the National Center for Health Statistics. “This report is useful to document the most recent prevalence estimates of adults’ use of sleep medication and confirm that these differences still persist.”

Dr. Nishi Bhopal, a psychiatrist and sleep medicine doctor, says these findings are concerning for a few reasons.

“In women, sleep issues are often misdiagnosed. I see this in my clinical practice, where women might be diagnosed as having insomnia when they actually have sleep apnea, because sleep apnea can show up very differently in women than it can in men,” said Bhopal, who was not involved in the new study.

Bhopal also found it alarming that the highest use of sleep meds was among older adults, for whom they are generally not recommended.

“Sleeping pills have a lot of side effects, and older adults are more prone to experiencing the negative effects of these medications. These include things like confusion, the risk of falling, breaking bones, and even are at a higher risk of cognitive issues like dementia. And so to see that the highest rate of use in this population is concerning.”

She added that “it’s striking, but it is not surprising” that sleeping medication use increased with decreased income. Other research has found that people with higher rates of financial stress and debt have more sleep issues and are more likely to be prescribed sleep medications.

Health effects of long-term sleeping pill use

Experts say that sleeping medication can be helpful tools when used for their intended purpose. They may be useful for people who are going through acute stressors that make it difficult to sleep, such as divorce, job loss or grief.

“It’s really important that we support patients in the best way that we can, because insomnia can lead to depression and anxiety,” Bhopal said. “So sleeping pills can be really useful in that context, but it’s not recommended to use them for more than two weeks.”

Using a sleeping medication every day can lead to problems such as tolerance, in which the body physically requires a higher dose of the medication to have an effect, or dependence, in which stopping the medication leads to withdrawal symptoms like seizures. People may also have rebound insomnia, meaning they can’t sleep without the medication.

Like a lack of sleep itself, consistent sleeping medication use can have serious health consequences.

Research has found that older people regularly taking sedative-hypnotic drugs have a five times higher risk of memory and concentration issues and a four times higher risk of daytime fatigue and sleepiness, which can lead to poor work performance or higher risk of car accidents.

Getting good sleep

Bhopal recommends using sleeping medications “for the shortest period of time, at the minimal doses needed. We’ll try to use them intermittently for support while we work on good behavioral strategies and addressing the other issues that are contributing to their sleep problems,” she said.

Those behavior strategies include keeping a consistent sleep schedule, getting regular exercise, managing stress during the day and limiting caffeine and alcohol in the evening.

For those who continue to have difficulty sleeping, Bhopal says cognitive behavioral therapy for insomnia may help.

“CBTI is the first-line gold standard treatment for chronic insomnia. It’s much more than sleep hygiene. It actually addresses the issues that perpetuate insomnia, and it helps people kind of reframe their thoughts about their sleep, and it also gives them very practical tools to help restore their kind of natural sleep wake cycle.”

If you’re constantly dealing with sleep problems, talk to your doctor to identify potential root causes.

“I think the main thing is to not to be afraid to talk to your doctor about your sleep issues,” said Bhopal, “and to ask about cognitive behavioral insomnia, to ask about sleep apnea, to ask about restless leg syndrome if you think you have any of those conditions.”