Those Sleeping Pills May Be Killing You 237
dstates writes "A recent article in in BMJ Open reports a strong association between the use of prescription sleeping pills and mortality. The study used electronic health records for 2.5 million people covered by the Geisinger Health System to find 12 thousand who had been prescribed sleeping pills and a matched set of controls. Death rates were much higher in the patients taking sleeping pills and the risk increases with age. Kudos to the authors for publishing this in an open access journal."
Re:Correllation != Causation (Score:5, Informative)
A matched set of controls in your example would be people with comparable heart disease who were not given the medixation. It appears that they have done that in this study:
Models addressing potential confounding of mortality association by health status To further address the possibility that hypnotic-associated hazards were due to use of hypnotic drugs by patients with a greater burden of disease, so that elevated risks of death might be attributable to comorbidities rather than to hypnotic medications, we conducted analyses within subgroups of hypnotic non-users and users defined by diagnoses in specific disease classes (supplemental table 7). Allowing for differences in sample size, hazards in subgroups restricted to patients with specific diseases were generally consistent with the overall findings. We also observed no statistically reliable differences in death HR in subgroups constructed to assess the overall burden of disease by stratifying on the total number of comorbidities diagnosed for each patient, and no reliable differences in death HR comparing groups diagnosed with different numbers of comorbidity classes. Whereas the raw death rate of the user cohort was 4.86 times that of non-user controls (table 1), adjustment for all covariates (eg, age, gender, BMI, smoking) with stratification by comorbidities only reduced the overall HR to 4.56 (95% CI 3.95 to 5.26).
Re:Correllation != Causation (Score:5, Informative)
They said "matched set of controls," not "general populace." How do you know they did it wrong?
By RTFA, which I strongly advise you to do before jumping in to comment. They matched them on other factors like gender, sex, occupation etc, but not sleep trouble. Since lack of good sleep is a proven strong factor in heart disease and cancer, I feel that they did it wrong.
Re:Melatonin? (Score:4, Informative)
Melatonin is fine and I highly recommend its use, opposed to traditional sleep aids (I use it). Melatonin is a sleep aid, in that it aids you in falling asleep... but it is different from traditional (prescription) sleep aids such as Ambien, in that it is a hormone supplement.
Melatonin is a non-benzodiazepine, while traditional sleep aids are benzodiazepines. Melatonin (N-acetyl-5 methoxytryptamine) is a compound naturally created in the pineal gland of the brain which triggers sleep. This should not be confused with the feeling of being tired, depleted of energy, or "heavy eyes." Traditional sleep aids act more like an anesthetic, actually making you feel tired and/or knocking you out.
Melatonin is non-habit forming, nor does the body develop tolerances for it, as in drugs like Ambien. It's kind of like a "passive" sleep aid, while Ambien/Benadryl/Lunesta/etc would be "active" sleep aids. There's a reason why it is available over-the-counter.
Note- while you can get Melatonin over-the-counter, you'll likely find nothing higher than 1mg doses (sometimes up to 3mg). You CAN, however, get a prescription for it. Then you can get a higher dose (up to 5mg?), in larger quantities (bottle of 40 as opposed to over-the-counter pack of 14ish), and your insurance will likely cover it.
Warning- with higher doses, especially if your body is already producing it's own, it may take a while for your body to expel the excess in the morning. This could make you feel groggy, make it hard to wake up, and make it too easy for you to fall back asleep (i.e. while driving). Take it 20-60min before sleep, sleep for at least 8 hours, give yourself 20-60min to wake up before driving.
Hope this helps! :o]
Should have been triple-blind... (Score:5, Informative)
Correlation!=causality (Score:4, Informative)
And the authors recognize this - from TFA:
"Cohort studies demonstrating association do not necessarily imply causality, but the preferable randomised controlled trial method for assessing hypnotic risks may be impractical due to ethical and funding limitations."
It's well-known that sleep disturbances are correlated with higher mortality. This study could simply be uncovering that people who have sleep disturbances (and who are therefore in a higher mortality group) are more likely to ask for meds to help them sleep. Can't see that there's any big news here.
not so fast on the melatonin, dude. (Score:5, Informative)
Re:Did they adjust for crazy? (Score:5, Informative)
You could have answered that with a simple act of RTFA. In short: no. They had no access to their subjects' mental health records.
I put up my screed on the weakness of the study (after seeing it covered by the Grauniad) at http://tmblr.co/ZaUL7yHBNSh0 [tmblr.co] before I saw it here, and the short version of my unassailable opinion is that it is a deeply flawed study whose data is just good enough to make a strong case for further study, undermined by the authors drawing unsupportable conclusions and pointlessly denigrating prior work and practical experience.
And yes, hypnotics are often taken by people for whom insomnia is a secondary condition grounded in deeper problems. That doesn't mean the hypnotics are not very useful in enabling them to address the deeper problems. Speaking from personal experience, a dozen doses of Ambien taken over the space of about 2 months during the breakup of my first marriage were critical to saving my job, my ability to eventually pull out of a deep depression, and possibly as many as 4 lives. When life is slicing deep enough that you cannot sleep for days on end, the lack of sleep itself gnaws on the stripped bones of sanity.
The main recommended use of hypnotics is for short periods in cases where insomnia itself is causing additional problems and more comprehensive treatments for underlying primary causes are too slow and/or are impeded by the effects of insomnia. Real primary insomnia that can be managed with hypnotics is pretty rare. A valid conclusion from the study is that people in that one HMO in rural PA who are being prescribed hypnotics are not getting adequate overall care, and that the inadequacy correlates with the amount of hypnotics that they are being prescribed. The authors claim (and I tend to believe them) that there is a growing consensus that CBT is a better treatment for chronic insomnia, but CBT is not something a doctor can write a scrip for and have the patient sleeping soundly that night for a few bucks. It can also uncover and address underlying issues like depression, OCD, and other cases where insomnia is really just a symptom of a more complex primary mental disorder. Of course, if you are a researcher specializing in retrospective studies of this sort who has been given access to a very large data set of patient records by an HMO, you don't have a strong incentive to write a conclusion that this HMO is controlling costs by encouraging doctors to prescribe cheap drugs instead of referring patients to expensive months-long rounds of a talk therapy, even when the best type seems to be the relatively efficient CBT.