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Medication for sleep disturbance among midlife women of little benefit over longer-term

Sleep disturbances are a common problem that can manifest in at least three different ways, e.g., difficulties in getting to sleep, remaining asleep or early morning awakening. There are several prescription treatments available for sleep disturbance including benzodiazepines, Z-drugs (e.g., zopiclone, zolpidem) and sedating antidepressants such as trazodone. While these medicines are only recommended for short-term use, for some patients, the chronic nature of the condition invariably results in continued use of treatment, either intermittently or regularly, for extended periods of time. In an effort to examine the effects of sleep medicines on patient-reported measures of sleep disturbance, a team from the Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, US, set out to examine the impact of sleep medicines among a cohort of midlife women. Eligible participants were drawn from the Study of Women’s Health Across the Nation (SWAN), which is an ongoing longitudinal study examining the biological and psychological changes that occur during the menopause transition. On an annual basis, women were asked to self-report on three aspects of sleep: difficulty initiating, frequent awakening and early morning awakening and anyone who reported on these disturbances at least once, were eligible for inclusion in the study. Women were asked about their sleep medication during each study visit and women were asked, using a 5-point Likert scale, to report their level of difficulty to each of the three sleep aspects and the authors also included a matched cohort of non-sleep medicine users. Furthermore, as sleep disturbances may arise because of depression, anxiety and pain, individuals also completed questionnaires to identify the impact of each of these factors.

The study included 238 women who had an initial prescription for sleep medication and who were matched to 447 non-users. There were no significant differences between the two groups with respect to depression, anxiety or pain scores. The mean age of those using sleep medicines was 49.5 years and at baseline, the mean score for initiating sleep was 2.7, waking frequently 3.8 and early morning wakening 2.8. Among non-users, the corresponding mean values were similar; 2.6, 3.7 and 2.7 respectively. After 1 year of use, the mean scores among sleep medicine users were 2.6 (initiating sleep) vs 2.3 (non-users), 3.6 (frequent wakening) vs 3.5 (non-users) and 2.8 (early morning wakening) vs 2.5 (non-users) and none of these differences were statistically significant. In addition, there was no difference in mean scores between the two main classes of sleep medicines, benzodiazepines and Z-drugs compared with non-users for the same three aspects of sleep. Furthermore, there were also no important differences between sleep medicine users/non-users after 2 years of follow-up. A further finding was how none of the patients in either group, reported a worsening of sleep disturbance over the two year follow-up period.

Commenting on these results, the authors noted that over the longer term, no sleep medicines were associated with a reduction in the three main aspects of sleep disturbance compared with those who did not use such treatments. They concluded that while sleep medicines are often used off-license, over longer periods of time, the results of the study demonstrate little benefit from continued use.

Soloman DH et al. Prescription medication for sleep disturbances among midlife women during 2 years of follow-up: a SWAN retrospective cohort study. BMJ Open 2021