Patients initially prescribed sleep medications for longer durations were more likely to still be using them years later, according to new research from the USC Schaeffer Center for Health Policy & Economics.
Sleep medications known as “Z-drugs,” which include Ambien and Lunesta, are often prescribed for insomnia long term, despite their indication for only short-term use (2-4 weeks) due to their increased risk of injury or dependence and the availability of safer, effective alternatives.
For the new study in JAMA Network Open, researchers analyzed nearly 20 years of prescription fills for roughly 130,000 U.S. patients using these medications.
Key findings
- Over 70% of patients initially received a supply of 25-34 days.
- Among patients who initially received up to a 14-day supply, 16% filled a prescription one year later. The share steadily increased as initial supplies rose, up to 38% for 25-34 days and 50% for 35 days or more
- While the chance of a refill decreased over seven years for all groups, patients with shorter initial prescriptions consistently received fewer refills than those with longer initial prescriptions.
“The first prescription may play an important role in shaping long-term use of sleep medications,” said lead author Jonathan Cloughesy, a PhD candidate at the USC Mann School of Pharmacy and Pharmaceutical Sciences. “It’s a strong indication of why doctors and patients should be cautious when starting on these medications.”
In a previous study, the researchers found that sleep medications appeared to do more harm than good in older adults, who are prescribed the drugs at higher rates. The research forecasted that if older adults on these medications stopped using them, then falls would drop 8.5%, cognitive impairment would drop 2.1%, life expectancy would rise by 0.11 years, and the country would experience economic savings totaling roughly $101 billion.
These studies are part of a National Heart, Lung, and Blood Institute (NHLBI) sleep science research project (R01HL167023) led by study co-author Jason Doctor, a senior scholar at the Schaeffer Center and professor at the USC Price School of Public Policy. The project aims to nudge doctors and patients toward using safer sleep treatments, such as cognitive behavioral therapy for insomnia, through digital prompts in electronic health records.
About the study
Other authors are Johanna Thunell and Xiaofan Liu of USC; Stephen Persell and Jeffrey Linder of Northwestern University; and Mark Sullivan of the University of Washington. See the study for authors’ disclosures.
NIH has no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
