By Suzanne Leigh
UCSF-led study shows benzos, antidepressants, Ambien may impact cognition
A new study shows that sleep medications increase the risk of dementia for people who are white. But the type and quantity of the medication may be factors in explaining the higher risk.
It follows previous work that shows people who are Black have a higher likelihood than people who are white of developing Alzheimer’s, the most common type of dementia, and that they have different risk factors and disease manifestations.
The final corrected draft of the study published in the Journal of Alzheimer’s Disease on Jan. 31, 2023.
Approximately 3,000 older adults without dementia, who lived outside of nursing homes, were enrolled in the Health, Aging and Body Composition study and followed over an average duration of nine years. Their average age was 74; 58% were white and 42% were Black. During the study, 20% developed dementia. White participants who “often” or “almost always” took sleep medications had a 79% higher chance of developing dementia compared to those who “never” or “rarely” used them. Among Black participants — whose consumption of sleep aids was markedly lower — frequent users had a similar likelihood of developing dementia as those who abstained or rarely used the medications.
Income may play a role in dementia
“Differences may be attributed to socioeconomic status,” said first author Yue Leng, PhD, of the UCSF Department of Psychiatry and Behavioral Sciences and UCSF Weill Institute for Neurosciences. “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."
“It’s also possible that some sleep medications were associated with a higher risk of dementia than others.”
The researchers found that people who are white, at 7.7%, were three times as likely as people who are Black, at 2.7%, to take sleep medications “often,” five to 15 times a month, or “almost always,” 16 times a month to daily. Whites were almost twice as likely to use benzodiazepines, like Halcion, Dalmane, and Restoril, prescribed for chronic insomnia.
People who are white were also 10 times as likely to take trazodone, an antidepressant known by the trade names of Desyrel and Oleptro, that may also be prescribed as a sleep aid. And they were more than seven times as likely to take “Z-drugs,” such as Ambien, a so-called sedative-hypnotic.
While future studies may offer clarity on the cognitive risks or rewards of sleep medications and the role that race may play, patients with poor sleep should hesitate before considering medications, according to Leng.
“The first step is to determine what kind of sleep issues patients are dealing with. A sleep test may be required if sleep apnea is a possibility,” she said. “If insomnia is diagnosed, cognitive behavioral therapy for insomnia (CBT-i) is the first-line treatment. If medication is to be used, melatonin might be a safer option, but we need more evidence to understand its long-term impact on health.”
Authors: Senior author is Kristine Yaffe, MD, of the UCSF Departments of Psychiatry and Behavioral Sciences, Neurology and Epidemiology. Co-author is Katie L. Stone, PhD, Department of Research Institute, California Pacific Medical Center, San Francisco.
Funding and Disclosures: Research was supported by the UCSF Claude D. Pepper Older Americans Independence Center, funded by National Institute on Aging, P30 AG044281. Leng is supported by the National Institute on Aging, P30 AG044281. Authors’ disclosures are available online.
Read the study
- Journal of Alzheimer's Disease: Race differences in the association between sleep medication use and risk of dementia
About UCSF Psychiatry and Behavioral Sciences
The UCSF Department of Psychiatry and Behavioral Sciences and the Langley Porter Psychiatric Institute are among the nation's foremost resources in the fields of child, adolescent, adult, and geriatric mental health. Together they constitute one of the largest departments in the UCSF School of Medicine and the UCSF Weill Institute for Neurosciences, with a mission focused on research (basic, translational, clinical), teaching, patient care, and public service.
UCSF Psychiatry and Behavioral Sciences conducts its clinical, educational, and research efforts at a variety of locations in Northern California, including the UCSF Nancy Friend Pritzker Psychiatry Building; UCSF Langley Porter Psychiatric Hospital; UCSF Medical Centers at Parnassus Heights, Mission Bay, and Mount Zion; UCSF Benioff Children’s Hospitals in San Francisco and Oakland; Zuckerberg San Francisco General Hospital and Trauma Center; the San Francisco VA Health Care System; UCSF Fresno; and numerous community-based sites around the San Francisco Bay Area.
About the UCSF Weill Institute for Neurosciences
The UCSF Weill Institute for Neurosciences, established by the extraordinary generosity of Joan and Sanford I. "Sandy" Weill, brings together world-class researchers with top-ranked physicians to solve some of the most complex challenges in the human brain.
The UCSF Weill Institute leverages UCSF’s unrivaled bench-to-bedside excellence in the neurosciences. It unites three UCSF departments—Psychiatry and Behavioral Sciences, Neurology, and Neurological Surgery—that are highly esteemed for both patient care and research, as well as the Neuroscience Graduate Program, a cross-disciplinary alliance of nearly 100 UCSF faculty members from 15 basic-science departments, as well as the UCSF Institute for Neurodegenerative Diseases, a multidisciplinary research center focused on finding effective treatments for Alzheimer’s disease, frontotemporal dementia, Parkinson’s disease, and other neurodegenerative disorders.
The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF’s primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area.