With 40 to 70% of older adults suffering from chronic sleep conditions, it’s no surprise why so many take sleeping medications to help them fall asleep and feel relief. However, a new study published in the Journal of Alzheimer’s Disease warns reaching for sleeping pills could actually be harmful to your brain health.
Researchers from the University of California-San Francisco found older adults who frequently take sleeping medications including Benzos, Ambien and antidepressants may increase their risk of developing Alzheimer’s disease (AD) and dementia.
The study monitored about 3,000 older adults without dementia who lived independently and were enrolled in the Health, Aging and Body Composition study, which followed them over nine years. The participants’ average age was 74; 58 percent of the participants were white and 42 were Black.
Sleep medication use and racial differences
The research team found over a nine-year period, 20 percent of the participants were diagnosed with dementia. White participants who frequently or almost always took sleeping medications had a 79% higher chance of developing dementia compared to those who never or rarely used sleeping pills. On the other hand, Black participants who regularly took sleeping pills had a similar risk of developing dementia as the participants who abstained or rarely used the medications.
Furthermore, the researchers determined that white participants (7.7%) were three times more likely than Black participants (2.7%) to take sleep medications “often” (five to 15 times a month), or “almost always” (16 times a month to daily). White patients were almost twice as likely to use benzodiazepines, like Halcion, Dalmane and Restoril, which are medications prescribed for chronic insomnia, the researchers reported.
White participants were also 10 times as likely to take trazodone, also known under the brand names Desyrel and Oleptro, which are antidepressants that can be prescribed as a sleep aid. They were also more than seven times as likely to take “Z-drugs,” like Ambien, which is used to treat sleep problems and insomnia in adults.
“Differences may be attributed to socioeconomic status,” said first author of the study, Yue Leng, PhD, of the UCSF Department of Psychiatry and Behavioral Sciences and UCSF Weill Institute for Neurosciences in a press release. “Black participants who have access to sleep medications might be a select group with high socioeconomic status and, thus greater cognitive reserve, making them less susceptible to dementia.
Leng added another possible reason is that some sleep medications were associated with a higher risk of dementia than others.
Other experts not involved in the study say while more research is needed to understand the relationship and differences between race and the risk of dementia associated with sleeping pill use, one potential reason includes differences in genetics.
“There are genetic differences between racial groups that could influence the risk of developing dementia, including differences in the expression of genes involved in sleep regulation and those associated with dementia risk,” Dung Trinh, MD, chief medical officer and co-founder of the Healthy Brain Clinic, told Seasons.
Lifestyle factors between racial groups could also affect the risk of developing dementia, such as diet, physical activity, stress, and exposure to environmental toxins, Trinh said. In addition, there may be differences in access to healthcare between racial groups, including access to sleep medications and access to healthcare for treating sleep disorders that could impact differences in risk between racial groups.
“It’s crucial to remember that race should not be used as a determinant for whether or not someone should use sleeping pills, as the decision to use these medications should be based on an individual’s specific medical needs and made in consultation with a healthcare provider,” Trinh added.
Links between sleeping medications and Alzheimer’s disease
There could be several reasons why sleeping medication use can increase the risk of AD and dementia, including that people who are triggered to take sleeping pill medications in the first place often may have an unidentified sleep disorder like sleep apnea, which causes disrupted sleep and awakenings, Rhonna Shatz, DO, Bob and Sandy Heimann Chair in Alzheimer’s Disease Research and Education Director of the Brain Health Clinic, University of Cincinnati, Department of Neurology and Rehabilitation, told Seasons.
Shatz said untreated sleep apnea prevents the normal sleep cycle progression into deep sleep, the stage in which toxic neurodegenerative proteins such as amyloid (associated with AD) and alpha-synuclein (associated with Parkinson’s) are cleared by the brain’s glymphatic system.
“Over many years, the accumulation of these proteins will trigger changes that lead to progressive neuronal loss and its accompanying cognitive decline,” she said.
Shatz added sleep medications have unintended chemical properties called anticholinergic side effects, which reduce the availability of an important signaling neurotransmitter, acetylcholine, in the brain network commonly affected by AD.
Trinh said because the neurotransmitter acetylcholine is involved in learning and memory processes, if there is a decrease in its levels, it can increase the risk of dementia.
“When acetylcholine levels are reduced it causes the default network to be less efficient in crystalizing new memory, require more energy than normal to function, and borrow resources from other networks,” Shatz said. “Over time, like any inefficient machine, the stress from ‘work arounds’ causes the network to fail and cognitive problems to manifest.”
She added that having impaired sleep due to poor sleep habits can also independently of the use of sleep medications cause low metabolism and activity in the default network, which itself can cause dementia risk.
It’s important to note that while these theories exist, Trinh said they are still being explored and more research is needed to fully understand the relationship between sleeping pill use and dementia risk.
“Additionally, the risk of dementia associated with sleeping pill use may vary based on several factors, including the type and dose of medication, the duration of use, individual differences in genetics and lifestyle.”
What this means for you
Despite the findings from this study, more research is needed to find cause and effect before clinical recommendations can be made, especially as it relates to stopping the use of sleeping medications, Percy Griffin, PhD, director of scientific engagement for the Alzheimer’s Association, told Seasons in an email.
“This research should not be cause for alarm but rather an opportunity for individuals to discuss their medications and sleep hygiene with their doctor,” he said.
If you are a caregiver or older adult currently using sleeping pills Trinh said it’s important to talk with your healthcare provider about your individual risk for developing dementia and the potential benefits and risks of continuing to use sleeping medications.
In addition, if your doctor determines that the benefits of taking sleeping pills outweigh the potential risks, Trinh suggests that you ask your doctor about alternative treatments, such as behavioral therapies or changes to sleep hygiene.
Lastly, he said if your doctor prescribes you sleeping pills it’s crucial to use them as directed by your provider and only for short periods of time. Caregivers and older adults should also avoid using multiple sleep medications at the same time, as they can increase the risk of side effects.
“It’s important to keep in mind that these recommendations are based on the current state of research and the individual needs of each person,” Trinh said. “It is always best to consult with a doctor before making any changes to your sleep medication or sleep habits.”