National use of prescription medications for insomnia: NHANES 1999-2010

Abstract

Study objectives: To determine current patterns and predictors of use of prescription medications commonly used for insomnia (MCUFI) in the U.S.

Design: Cross-sectional study.

Setting: National Health and Nutrition Examination Survey, 1999-2010.

Participants: 32,328 noninstitutionalized community-dwelling U.S. adults.

Interventions: N/A.

Measurements and results: WE DEFINED MCUFI USE AS USE OF ANY OF THE FOLLOWING MEDICATIONS IN THE PRECEDING MONTH: benzodiazepine receptor agonists (eszopiclone, zaleplon, zolpidem, estazolam, flurazepam, quazepam, temazepam, triazolam), barbiturates (amobarbital, amobarbitalsecobarbital, chloral hydrate), doxepin, quetiapine, ramelteon, and trazodone. We estimated prevalence of MCUFI use and concurrent use of another sedating medication. We determined predictors of MCUFI use using multivariate logistic regression. Overall, 3% percent of adults used a MCUFI within the preceding month. Zolpidem and trazodone were used most commonly. Overall MCUFI use increased between 1999-2000 and 2009-2010 (P value for trend < 0.001). Concurrent use of other sedating medications was high, with 55% of MCUFI users taking at least one other sedating medication and 10% taking ≥ 3 other sedating medications. Concurrent use of MCUFIs with opioids (24.6%) and non-MCUFI benzodiazepines (19.5%) were most common. After adjustment, adults seeing a mental health provider (aOR 4.68, 95% C.I. 3.79, 5.77), using other sedating medications (aOR 4.18, 95% C.I. 3.36, 5.19), and age ≥ 80 years (aOR 2.55, 95% C.I. 1.63, 4.01) had highest likelihood of MCUFI use.

Conclusion: In this nationally representative sample, reported use of prescription medications commonly used for insomnia (MCUFIs) within the preceding month was common, particularly among older adults and those seeing a mental health provider, with high use of sedative polypharmacy among MCUFI users.

Keywords: Insomnia; NHANES; benzodiazepines; hypnotics and sedatives; prescription medication use; sleep disorders.

Figure 1

Prescription medication commonly used for insomnia (MCUFI), past month: 1999-2010. *Unreliable estimate (n < 30). **P value for trend < 0.001. Z-meds: eszopiclone, zaleplon, zolpidem.