STUDY OBJECTIVES: Despite mounting evidence for the overuse of prescription sleep aids (PSA), reliable data on PSA use among insomniacs are unavailable. Current studies focus on trends in PSA use at the general population level, and thus do not distinguish between transient sleep disturbance and insomnia disorder. Therefore, we prospectively examined the prevalence and predictors of baseline and chronic PSA use in a well-defined sample of individuals with insomnia. METHODS: We analyzed longitudinal data from an urban, community-based cohort of 649 adults (48.1 ± 11.6 y; 69.3% female) with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-based insomnia disorder. Participants completed standardized measures of sleep disturbance, daytime alertness, depression, and anxiety at baseline and follow-up 1 y later. They also reported whether and with what frequency they used PSA at both time points. RESULTS: Approximately 19% of the sample used PSA at baseline, the majority (69.4%) of whom continued use 1 y later. Anxiety and daytime alertness were the only independent predictors of both acute and chronic PSA use. An increase of 1 standard deviation (SD) in alertness was associated with a 33% increase in the odds of chronic PSA use (χ(2) = 4.98; odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.04-1.72; P < 0.05), and a 1-SD increase in anxiety was associated with a 41% increase (χ(2) = 6.95; OR = 1.41; 95% CI: 1.09-1.82; P < 0.05). Chronic PSA users did not report any significant improvements in sleep from baseline to follow-up relative to nonusers. CONCLUSIONS: Hyperarousal, as indexed by daytime alertness and anxiety, is a strong determinant of PSA use among individuals with insomnia. These findings are consistent with emerging data showing that insomnia is not just a nocturnal sleep disorder, but one characterized by 24-h arousal. Though current research targets sleep disturbance, this study highlights the role of the arousal system in pharmacological treatment seeking.
STUDY OBJECTIVES: Despite mounting evidence for the overuse of prescription sleep aids (PSA), reliable data on PSA use among insomniacs are unavailable. Current studies focus on trends in PSA use at the general population level, and thus do not distinguish between transient sleep disturbance and insomnia disorder. Therefore, we prospectively examined the prevalence and predictors of baseline and chronic PSA use in a well-defined sample of individuals with insomnia. METHODS: We analyzed longitudinal data from an urban, community-based cohort of 649 adults (48.1 ± 11.6 y; 69.3% female) with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-based insomnia disorder. Participants completed standardized measures of sleep disturbance, daytime alertness, depression, and anxiety at baseline and follow-up 1 y later. They also reported whether and with what frequency they used PSA at both time points. RESULTS: Approximately 19% of the sample used PSA at baseline, the majority (69.4%) of whom continued use 1 y later. Anxiety and daytime alertness were the only independent predictors of both acute and chronic PSA use. An increase of 1 standard deviation (SD) in alertness was associated with a 33% increase in the odds of chronic PSA use (χ(2) = 4.98; odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.04-1.72; P < 0.05), and a 1-SD increase in anxiety was associated with a 41% increase (χ(2) = 6.95; OR = 1.41; 95% CI: 1.09-1.82; P < 0.05). Chronic PSA users did not report any significant improvements in sleep from baseline to follow-up relative to nonusers. CONCLUSIONS: Hyperarousal, as indexed by daytime alertness and anxiety, is a strong determinant of PSA use among individuals with insomnia. These findings are consistent with emerging data showing that insomnia is not just a nocturnal sleep disorder, but one characterized by 24-h arousal. Though current research targets sleep disturbance, this study highlights the role of the arousal system in pharmacological treatment seeking.
Authors: Thomas Roth; Catherine Coulouvrat; Goeran Hajak; Matthew D Lakoma; Nancy A Sampson; Victoria Shahly; Alicia C Shillington; Judith J Stephenson; James K Walsh; Ronald C Kessler Journal: Biol Psychiatry Date: 2010-12-31 Impact factor: 13.382
Authors: Ana Ribeiro; Rachel Gabriel; Bernardo Garcia; Casey Cuccio; William Aqeel; Alejandro Moreno; Colby Landeen; Arlene Hurley; Neil Kavey; Donald Pfaff Journal: Proc Natl Acad Sci U S A Date: 2022-06-13 Impact factor: 12.779
Authors: Janet M Y Cheung; Denise C Jarrin; Simon Beaulieu-Bonneau; Hans Ivers; Geneviève Morin; Charles M Morin Journal: Sleep Date: 2021-11-12 Impact factor: 6.313
Authors: Rebecca Robbins; Ralph J DiClemente; Andrea B Troxel; Girardin Jean-Louis; Mark Butler; David M Rapoport; Charles A Czeisler Journal: Sleep Med Date: 2020-11-11 Impact factor: 3.492
Authors: Víviam Vargas Barros; Emérita Sátiro Opaleye; Marcelo Demarzo; Sarah Bowen; Daniela Fernández Curado; Helena Hachul; Ana Regina Noto Journal: PLoS One Date: 2018-03-16 Impact factor: 3.240