Sleeping pills and death

Hypnotics’ association with mortality or cancer: a matched cohort study

Daniel F Kripke1, Robert D Langer2, Lawrence E Kline1
+ Author Affiliations

Abstract
Objectives An estimated 6%–10% of US adults took a hypnotic drug for poor sleep in 2010. This study extends previous reports associating hypnotics with excess mortality. […]

Subjects Subjects (mean age 54 years) were 10 529 patients who received hypnotic prescriptions and 23 676 matched controls with no hypnotic prescriptions, followed for an average of 2.5 years between January 2002 and January 2007.

Main outcome measures Data were adjusted for age, gender, smoking, body mass index, ethnicity, marital status, alcohol use and prior cancer. Hazard ratios (HRs) for death were computed from Cox proportional hazards models controlled for risk factors and using up to 116 strata, which exactly matched cases and controls by 12 classes of comorbidity.

Results As predicted, patients prescribed any hypnotic had substantially elevated hazards of dying compared to those prescribed no hypnotics. For groups prescribed 0.4–18, 18–132 and >132 doses/year, HRs (95% CIs) were 3.60 (2.92 to 4.44), 4.43 (3.67 to 5.36) and 5.32 (4.50 to 6.30), respectively, demonstrating a dose–response association. HRs were elevated in separate analyses for several common hypnotics, including zolpidem, temazepam, eszopiclone, zaleplon, other benzodiazepines, barbiturates and sedative antihistamines. Hypnotic use in the upper third was associated with a significant elevation of incident cancer; HR=1.35 (95% CI 1.18 to 1.55). Results were robust within groups suffering each comorbidity, indicating that the death and cancer hazards associated with hypnotic drugs were not attributable to pre-existing disease.

Conclusions Receiving hypnotic prescriptions was associated with greater than threefold increased hazards of death even when prescribed <18 pills/year. This association held in separate analyses for several commonly used hypnotics and for newer shorter-acting drugs. Control of selective prescription of hypnotics for patients in poor health did not explain the observed excess mortality.

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4 comments
dearieme says January 14, 2013

But is it the drugs that are killing ’em, or the prior (or ongoing) shortage of sleep, or the cause of the shortage of sleep?

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Mangan says January 14, 2013

Elsewhere the same investigator found no difference in mortality between those who sleep 4 or 5 hours a night (I forget the exact numbers) and those who sleep 8, with higher mortality in those sleeping more than 8. So it appears that even quite severe insomnia isn’t much of a health risk, but sleeping more is. To the extent that pills make one sleep more, that could be a health risk, but the authors also note a number of plausible reasons why sleeping pills could cause cancer and other higher mortality.

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[…] Fix: get a good night’s sleep. use of blue-blocking glasses and/or melatonin may be useful. Sleeping pills are bad news, and are related to a much higher risk of death. […]

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[…] in several studies that even a brief use of sleeping pills, as little as a few times a year, is associated with greatly increased risk of mortality. Every class of sleeping pill that was examined showed increased risk, which leads one to speculate […]

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