Prescription medications for sleep disturbances among midlife women during 2 years of follow-up: a SWAN retrospective cohort study

• Published in: BMJ open 2021-05, Vol.11 (5), p.e045074-e045074
• Main Authors: Solomon, Daniel H, Ruppert, Kristine, Habel, Laurel A, Finkelstein, Joel S, Lian, Pam, Joffe, Hadine, Kravitz, Howard M
• Format: Article
• Language: English
• Subjects: Clinical outcomes; Cohort analysis; Drug therapy; Epidemiology; Insomnia; Middle age; Patients; Prescription drugs; Sleep; Sleep disorders; sleep medicine; therapeutics; Womens health
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-045074

ObjectiveTo examine the effects of prescription sleep medications on patient-reported sleep disturbances.DesignRetrospective cohort.SettingLongitudinal cohort of community-dwelling women in the USA.ParticipantsRacially and ethnically diverse middle-aged women who reported a sleep disturbance.InterventionsNew users of prescription sleep medications propensity score matched to women not starting sleep medications.Main outcomes and measuresSelf-reported sleep disturbance during the previous 2 weeks—difficulty initiating sleep, waking frequently and early morning awakening—using a 5-point Likert scale, ranging from no difficulty on any night (rating 1) to difficulty on 5 or more nights a week (rating 5). Sleep disturbances were compared at 1 year (primary outcome) and 2 years of follow-up.Results238 women who started sleep medications were matched with 447 non-users. Participants had a mean age of 49.5 years and approximately half were white. At baseline, sleep disturbance ratings were similar: medication users had a mean score for difficulty initiating sleep of 2.7 (95% CI 2.5 to 2.9), waking frequently 3.8 (95% CI 3.6 to 3.9) and early morning awakening 2.8 (95% CI 2.6 to 3.0); non-users ratings were 2.6 (95% CI 2.5 to 2.7), 3.7 (95% CI 3.6 to 3.9) and 2.7 (95% CI 2.6 to 2.8), respectively. After 1 year, ratings for medication users were 2.6 (95% CI 2.4 to 2.8) for initiating sleep, 3.6 (95% CI 3.4 to 3.8) for waking frequently and 2.8 (95% CI 2.6 to 3.0) for early morning awakening; for non-users, the mean ratings were 2.3 (95% CI 2.2 to 2.5), 3.5 (95% CI 3.3 to 3.6) and 2.5 (95% CI 2.3 to 2.6), respectively. None of the 1 year changes were statistically significant nor were they different between medication users and non-users. Two-year follow-up results were consistent, without statistically significant reductions in sleep disturbance in medication users compared with non-users.ConclusionsThese analyses suggest that women who initiated sleep medications rated their sleep disturbances similar after 1 and 2 years. The effectiveness of long-term sleep medication use should be re-examined.