March 6, 2023 – Janet S., a 76-year-old retired journalist from Delaware, recently developed mild cognitive impairment, which is usually a precursor to dementia.
“At first I thought my forgetfulness and disorganization were just normal 'senior moments,' but then the doctor did some tests and we realized there was more to it,” she says.
Janet, who asked that her last name not be utilized in this text, suffers from insomnia and has taken sleeping pills frequently for a few years. “I most often take Ambien (zolpidem), but when I have anxiety, I also take Valium (diazepam, a benzodiazepine),” she says.
“I know Ambien affects my memory, even in the short term, because when I wake up in the morning I find strange things – like an empty ice cream tub with a spoon on my nightstand. That means I clearly ate the ice cream during the night but don't remember it. And the Valium makes me groggy.”
Sleeping pills and dementia risk
A brand new study recently published in Journal of Alzheimer's Disease has linked excessive use of sleeping pills to the later development of dementia.
The researchers studied over 3,000 older adults without dementia with a mean age of 74. The study consisted of 58% white and 42% black participants.
During the 15-year study period, one fifth of the participants developed dementia.
Nearly 8% of whites and nearly 3% of blacks within the study reported taking sleeping pills either “often” or “almost always.”
White participants took sleeping pills almost twice as often as black participants. Certain medications specifically were taken much more regularly by white participants than by 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 |
| Sometimes antidepressants are used as sleeping pills |
Desyrel (trazodone) Oleptro (Trazodone) |
10 times more likely |
| Sedative-hypnotics (“Z-drugs”) are sometimes prescribed as sleeping pills | Ambien (Zolpidem) | More than 7 times more likely |
White people within the study who took sleeping pills “often” or “almost always” had a 79% higher risk of developing dementia than those that took them “rarely” or “never.” On the opposite hand, black individuals who took sleeping pills regularly had the same likelihood of developing dementia as those that took them rarely or never.
There was no increased risk of dementia amongst participants who “sometimes” took sleeping pills.
The study's authors suspect that racial bias may play a task of their findings. Other studies have shown that older black adults are significantly less prone to receive prescriptions for certain medications, particularly benzodiazepines, than older white adults of non-Hispanic origin. And the present study shows that white participants are greater than twice as prone to take benzodiazepines as black participants.
This suggests that the black participants within the study can have been taking medications which are less related to dementia risk in comparison with the white participants.
“Further studies on sleeping pills will help [us] to understand possible mechanisms, particularly the observed racial differences,” the authors explain.
Do sleeping pills really cause dementia?
“Research suggests a possible link between long-term use of sleeping pills and an increased risk of dementia,” says Dr. Dung Trinh, chief medical officer of Irvine Clinical Research in California. “But this link is not yet fully understood, and more research is needed to confirm a possible causal link,” says Trinh, who can also be medical director of the Healthy Aging Center at Acacia and chief medical officer of the Healthy Brain Clinic in Long Beach, California.
The query that should be clarified is “whether the sleeping pills are the cause of dementia or whether they merely reflect the severity of the underlying insomnia, which increases the risk of dementia,” says Trinh, who was not involved in the present study.
The mechanism that may be accountable for this connection can also be “not yet fully understood,” but some studies “suggest that these drugs may affect the concentration of certain chemicals in the brain, such as acetylcholine, which is involved in memory and learning processes,” says Trinh.
Benzodiazepines and “Z-drugs,” specifically, can have a more damaging effect on the brain than other sorts of sleep aids. These drugs are thought to affect the degrees of certain chemicals within the brain, “which may lead to cognitive impairment and an increased risk of developing Alzheimer's disease over time.”
An essential caveat is that “each person may react differently to different types of sleep medications,” notes Trinh. “Personal consultation with a physician is recommended before starting or stopping any medication.”
Maintaining a healthy brain
Trinh believes it is necessary to lift awareness in regards to the possible link between long-term use of certain sorts of sleeping pills and an increased risk of developing Alzheimer's disease.
“This education can help people suffering from sleep disorders make informed decisions about their treatment options, weighing the benefits and risks of different types of medications,” he says.
More broadly, education about healthy brain function “typically refers to the process of teaching individuals strategies and lifestyle choices that can promote brain health and reduce the risk of cognitive decline over time,” Trinh explains.
This may include information on proper nutrition, physical exertion, sleep hygiene, stress management techniques and cognitively stimulating activities equivalent to doing puzzles or learning recent skills, in addition to raising awareness of the potential risks of certain behaviours or environmental aspects equivalent to smoking, excessive alcohol consumption or exposure to toxins.
“The goal of brain health education is to give people the knowledge and tools they need to take an active role in maintaining their brain health throughout their lives,” he says.
Janet feels lucky to have been given medication that helped her sleep, but “could the sleeping pills have contributed to my cognitive symptoms? Was it a worthwhile trade-off? I don't know,” she says, reflecting on the brand new research.
She desires to explore ways to enhance her brain health and her sleep. To improve her brain health, she’s going to start together with her eating regimen.
“I need to eat less ice cream and eat more healthy foods like fruits and vegetables,” she says. “I also need to participate in social activities that stimulate my brain – maybe join a book club or volunteer.”
She believes rest techniques can improve her sleep, so she's on the lookout for a brand new yoga class to learn respiration exercises. And she's considering psychotherapy.
“Stress contributes to my insomnia and perhaps therapy can help me deal with these problems,” she says.