Do Sleep Medications Increase Your Risk of Dementia?

Sleep medicines can help when you have trouble falling asleep or keep waking during the night. If you take one regularly, you may wonder how long to continue using it and whether it could affect your memory as you get older.

For Roger Wong, PhD, a public health researcher at SUNY Upstate Medical University, the concern began at home. His father had been experiencing ongoing sleep problems since the COVID-19 pandemic began, and Wong wondered how that might affect his thinking and memory in the future.

“After reading the existing literature, I was surprised to see mixed findings on the sleep-dementia relationship, so I decided to investigate this topic.”

Roger Wong, PhD, lead author

Wong and co-author Margaret Anne Lovier went on to examine a decade of data on sleep problems, medication use, and dementia. Their study was published in the American Journal of Preventive Medicine in 2023.

What did the study find about sleep medications and dementia?

The researchers studied 6,284 U.S. adults aged 65 and older who lived in the community and did not have dementia at the start of the study. They used annual surveys collected between 2011 and 2020 through the National Health and Aging Trends Study.

Each year, participants reported how often they had taken medication to help them sleep during the previous month. The researchers tracked how consistently participants reported using it at least two nights a week over the years.

After accounting for age, income, education, and other background factors, more consistent sleep-medication use was associated with a 30% higher relative rate of dementia during follow-up.

When health conditions were added to the analysis, the estimate fell to 8% higher and was no longer statistically significant.

These percentages are relative estimates based on medication-use patterns over time. They do not mean that someone taking a sleeping pill has a 30% or 8% chance of developing dementia.

Why did health conditions change the result?

Depression can disrupt sleep and is also linked to dementia. Some medicines are prescribed for both depression and sleep problems, so medication use may reflect more than difficulty sleeping.

The researchers considered depression, anxiety, diabetes, high blood pressure, a history of heart attack, and other health measures, including whether participants needed help with everyday activities. Including these factors weakened the medication finding.

Do sleep medications cause dementia?

Researchers tracked participants’ reported sleep problems and medication use, then looked at who developed dementia. They did not assign people to take a particular medicine, so the study cannot establish whether medication caused the condition.

People may use prescription (Rx) sleep medications, over-the-counter (OTC) sleep aids, or supplements such as melatonin. Zolpidem, sold under the brand name Ambien, is a prescription sleep medication for insomnia. Some OTC sleep aids contain antihistamines, which can cause drowsiness.

The researchers did not record product names or doses, so they could not distinguish these options or assess the dementia risk of a particular product.

Although the authors reviewed earlier research on benzodiazepines and Z-drugs, they did not examine those medication groups separately and called for future research that records which medicines people use.

Everyone in the study was at least 65 when it began, so the findings should not be assumed to apply to younger adults. The researchers also examined dementia overall, without separating Alzheimer’s disease from other types.

What did the researchers find about insomnia?

Participants also reported taking more than 30 minutes to fall asleep and having difficulty returning to sleep after waking earlier than intended.

Trouble falling asleep was associated with a 51% higher relative dementia rate before adjustments. After adjusting for age, income, education, and other background factors, that finding was no longer statistically significant.

Trouble returning to sleep was associated with a 40% lower relative dementia rate, even after health conditions were included.

“We expected sleep-initiation insomnia and sleep medication usage to increase dementia risk, but we were surprised to find sleep-maintenance insomnia decreased dementia risk.”

Roger Wong, PhD, lead author

The researchers considered whether people with interrupted sleep might still get good-quality sleep overall. If so, extra waking time might allow more time for social or physical activities that help maintain thinking and memory.

They did not test that explanation or measure sleep stages. The finding does not show that waking up at night protects your brain or suggest that you should deliberately interrupt your sleep.

What should you do if you regularly take sleep medication?

Talk with your doctor or pharmacist about whether your medicine still helps, how long you have used it, and any side effects. Include OTC sleep aids and supplements, since these products may also affect your treatment.

Describe any ongoing difficulty falling or staying asleep, daytime tiredness, morning grogginess, or dizziness. Confusion or memory changes while taking zolpidem should be reported to your doctor promptly.

You can ask:

• How long should I keep taking this medicine?
• Could another health problem or medicine be affecting my sleep?
• What else could help if I am still not sleeping well?
• If we decide to change or stop treatment, how should I do that?
• Would cognitive behavioral therapy for insomnia help?

Some sleep medicines are intended for short-term use, while others may be used longer. Speak with your prescriber before changing or stopping yours.

What other options can help with ongoing insomnia?

Cognitive behavioral therapy for insomnia, or CBT-I, is usually the first treatment recommended for long-term insomnia. It addresses habits and worries that can keep sleep problems going.

Treatment typically lasts 6 to 8 weeks and can be delivered in person, by telephone, or online. It may include relaxation techniques, a regular sleep and wake schedule, and adjustments to time in bed, all under professional guidance.

Practicing good sleep hygiene can support those efforts too. For example, keep your room cool and quiet, unwind with a book or a warm bath, and avoid caffeine, nicotine, and alcohol close to bedtime.

If you’re looking for a sleep supplement without added melatonin and prefer to avoid sleeping pills, Sip2Sleep® combines Montmorency tart cherry extract with Venetron®, an extract from Rafuma leaf, to support the restful sleep your body needs.

Discuss supplements with your healthcare provider, especially if you already take medication for sleep or another health condition.

What to remember

The authors concluded that sleep-medication use “may elevate” dementia risk and called for further research. In their study, the link weakened and was no longer statistically significant after health conditions were included. It does not give a definite answer about whether sleep medications increase dementia risk.

If you regularly use sleep meds, ask your doctor or pharmacist to review whether your treatment is still appropriate.

About the Author

Dr. Ruchir P. Patel, MD, FACP, is the Medical Director of the Insomnia and Sleep Institute of Arizona and the founder of Sip2Sleep. He is triple board-certified in sleep medicine, obesity medicine, and internal medicine. Dr. Patel is a multi-year Phoenix Magazine Top Doctor and holds the Inspire Excellence designation.

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References

Wong R, Lovier MA. Sleep Disturbances and Dementia Risk in Older Adults: Findings From 10 Years of National U.S. Prospective Data. American Journal of Preventive Medicine. 2023;64(6):781–787. Original study.

Elsevier. Trouble falling asleep at bedtime or in the middle of the night? It could impact your risk for developing dementia. March 6, 2023. Source of Roger Wong’s comments.