Prevalence and Predictors of Prescription Sleep Aid Use among Individuals with DSM-5 Insomnia: The Role of Hyperarousal
Year: 2016
Type: article
Study design: Observational Study
Abstract: Despite mounting evidence for the overuse of prescription sleep aids (PSA), reliable data on PSA use among insomniacs are unavailable. Current studies focus on trends in PSA use at the general population level, and thus do not distinguish between transient sleep disturbance and insomnia disorder. Therefore, we prospectively examined the prevalence and predictors of baseline and chronic PSA use in a well-defined sample of individuals with insomnia. We analyzed longitudinal data from an urban, community-based cohort of 649 adults (48.1 ± 11.6 y; 69.3% female) with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-based insomnia disorder. Participants completed standardized measures of sleep disturbance, daytime alertness, depression, and anxiety at baseline and follow-up 1 y later. They also reported whether and with what frequency they used PSA at both time points. Approximately 19% of the sample used PSA at baseline, the majority (69.4%) of whom continued use 1 y later. Anxiety and daytime alertness were the only independent predictors of both acute and chronic PSA use. An increase of 1 standard deviation (SD) in alertness was associated with a 33% increase in the odds of chronic PSA use (χ2 = 4.98; odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.04–1.72; P < 0.05), and a 1-SD increase in anxiety was associated with a 41% increase (χ2 = 6.95; OR = 1.41; 95% CI: 1.09–1.82; P < 0.05). Chronic PSA users did not report any significant improvements in sleep from baseline to follow-up relative to nonusers. Hyperarousal, as indexed by daytime alertness and anxiety, is a strong determinant of PSA use among individuals with insomnia. These findings are consistent with emerging data showing that insomnia is not just a nocturnal sleep disorder, but one characterized by 24-h arousal. Though current research targets sleep disturbance, this study highlights the role of the arousal system in pharmacological treatment seeking. Though daytime impairment is an important symptom of insomnia disorder, clinical trials for pharmacologic treatments of insomnia focus primarily on its nocturnal symptoms. In addition to quantifying the prevalence of prescription sleep aid use, this study showed that daytime hyperarousal is a more reliable predictor of both current and future prescription sleep aid use among insomniacs than nocturnal sleep disturbance. This finding raises important questions: should clinicians consider daytime hyperarousal as a treatment target? Further, as insomniacs vary in the level of hyperarousal, should choice of treatment differ as a function of hyperarousal? Future research along these lines will help clinicians develop individualized treatment options for insomnia.
Source: SLEEP
DOI: 10.5665/sleep.5636
Institutions: Henry Ford Health, Henry Ford Hospital, University of Michigan
Language: English
Topic: Sleep and related disorders
Subfield: Experimental and Cognitive Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W2326434146