March 6, 2023 -- Janet S., a 76-year-old retired journalist from Delaware, recently developed mild cognitive impairment, which can be a precursor to dementia.
“At first, I thought my forgetfulness and disorganization were just normal ‘senior moments,’ but then the doctor did some testing and we realized it was more than that,” she says.
Janet, who asked that her last name not be used for this article, has insomnia and has used sleeping pills regularly for many years. “Most often, I use Ambien (zolpidem), but if I’m also anxious I might take Valium (diazepam, a benzodiazepine) as well,” she says.
“I know Ambien affects my memory, even short-term, because when I wake up in the morning, I’ll find strange things -- like an empty container of ice cream with a spoon on my night table, meaning I clearly ate the ice cream during the night but don’t remember doing so. And the valium makes me fuzzy-headed.”
Sleeping Pills and Dementia Risk
A new study recently published in the Journal of Alzheimer's Disease has linked heavy use of sleeping medications to the development of dementia later on.
Researchers studied over 3,000 older adults without dementia with an average age of 74. The study consisted of 58% white and 42% Black participants.
During the study period, which lasted 15 years, one-fifth of participants developed dementia.
Close to 8% of white people in the study and nearly 3% of Black people reported taking sleep medications either “often” or “almost always."
Those who were white were almost twice as likely as those who were Black to take sleeping medications. In particular, certain medications were far more commonly taken in white vs. Black participants:
| Drug Category | Examples | White vs Black Individuals |
| Benzodiazepines (often prescribed for chronic insomnia) | Dalmane (flurazepam) Halcion (triazolam) Restoril (temazepam) | Almost twice as likely |
| Antidepressant sometimes use to help people sleep | Desyrel (trazodone) Oleptro (trazodone) | 10 times as likely |
| Sedative-hypnotics (“Z-drugs") often prescribed as sleep aids | Ambien (zolpidem) | Over 7 times as likely |
White people in the study who “often” or “almost always” took sleep medications had a 79% higher chance of developing dementia compared to those who “rarely” or “never” used them. On the other hand, Black people who were frequent users of sleeping medication had a similar likelihood of developing dementia as did those who rarely or never used them.
There was no increased risk of dementia for participants who took sleeping medications “sometimes.”
The study authors suggest that racial bias might play a role in their findings. Other studies have shown that Black older adults are significantly less likely to receive prescriptions for certain medications, particularly benzodiazepines, as compared to non-Hispanic white older adults. And the current study shows that white people were more than twice as likely as Black participants to be taking benzodiazepines.
This implies that the Black people in the study may have been using medications less associated with dementia risk, compared to the white people.
“Further study of type of sleep medications will help [us] to understand potential mechanisms, especially for the observed race differences,” the authors state.
Do Sleeping Medications Really 'Cause' Dementia?
“Research has suggested a potential correlation between the long-term use of sleeping pills and an increased risk of dementia," says Dung Trinh, MD, chief medical officer of Irvine Clinical Research in California. But "this link is not fully understood, and more research is needed to confirm any causal relationship, says Trinh, who is also the medical director of the Healthy Aging Center in Acacia and the chief medical officer of the Healthy Brain Clinic in Long Beach, CA.
The questions that need to be explored are “whether the sleeping medications are the cause of dementia or simply reflecting the severity of the underlying insomnia that increases the risk for dementia,” says Trinh, who was not involved with the current study.
The mechanism that might be responsible for this link is also “not fully understood," but some studies “suggest that these medications may affect the levels of certain brain chemicals, such as acetylcholine, which are involved in memory and learning processes,” says Trinh.
In particular, benzodiazepines and “Z-drugs” may have a more damaging impact on the brain than other types of sleep medication. These medications are thought to affect the levels of certain chemicals in the brain, “which can lead to cognitive impairment and an increased risk of developing Alzheimer’s disease over time.”
An important caveat is that “each individual may react differently to different types of sleep medication,” Trinh notes. “Personalized advice from a health care professional is recommended before starting or discontinuing any type of medication.”
Maintaining a Healthy Brain
Trinh feels that education about the potential link between long-term use of certain types of sleeping medications and increased risk of developing Alzheimer’s disease is important.
“This education can help individuals who suffer from sleep disorders to make informed decisions about their treatment options, weighing the benefits and risks associated with different types of medication,” he says.
In broader terms, healthy brain education “typically refers to the process of teaching individuals about strategies and lifestyle choices that can promote brain health and reduce the risk of cognitive decline over time,” Trinh explains.
This might include information about proper nutrition, exercise, sleep hygiene, stress management techniques, and cognitive stimulation activities such as puzzles or learning new skills, as well as raising awareness about potential risks of certain behaviors or environmental factors, such as smoking, excessive alcohol consumption, or exposure to toxins.
“The goal of healthy brain education is to empower individuals with the knowledge and tools they need to take an active role in maintaining their brain health throughout their life span,” he says.
Janet considers herself fortunate to have received medications that have helped her sleep. But "could the sleeping meds have contributed to my cognitive symptoms? Was it a worthwhile trade-off? I don’t know," she says, in light of the new research.
She plans to explore ways to improve brain health as well as sleep. For brain health, she’s going to start with her diet.
“I need to cut down on ice cream and eat more healthy foods, like vegetables and fruits,” she says. “I also need to participate in social activities that stimulate my brain -- maybe join a book club or volunteer.”
She feels that relaxation techniques can improve her sleep, so she’s looking into a new yoga class to learn breathing exercises. And she’s considering psychotherapy.
"Stress contributes to my insomnia, and maybe therapy can help me deal with these issues," she says.
