Link between mental illness and sleep aid use

A possible link exists between mental illness and using sleep aids.

In today's "always on," high-stress world, it has become commonplace to turn to over-the-counter sleep aids for a little help with drifting off into dreamland at night. However, that habit, if made a consistent one, could lead to potentially serious damage when it comes to ones mental health.

A new study zeroing in on anticholinergic drugs -- a category that includes common non-prescription sleeping aids and antihistamines like Benadryl -- found that the long-term use of such medications in higher doses can lead to an increased risk of developing dementia, including Alzheimer's disease, in the future. It's the first study of its kind to prove this dose-response effect, meaning that the higher, cumulative consumption of the drug, the higher the likelihood of a person developing dementia later in life. It's also the first to suggest that this dementia risk may persist -- and be irreversible -- even years after people have stopped taking these drugs. The study was published in JAMA Internal Medicine in late January.

Dr. Shelly Gray, a professor at the University of Washington's School of Pharmacy and lead author of this study, originally intended to disprove this association that had been researched previously and published last year with her more rigorous study design, she told The Huffington Post. Dr. Gray and her colleagues tracked approximately 3,5000 men and women aged 65 and older who exhibited no dementia symptoms at the beginning of the study. Each participant was part of the joint Group Health–University of Washington study funded by the National Institute on Aging, which made it more efficient for them to track exposure to anticholinergic drugs via each person's pharmacy computer records.

Anticholinergics, which block the neurotransmitter acetylcholine in the brain and body, are typically taken to address gastrointestinal problems, urinary issues, respiratory disorders and insomnia, with side effects ranging from drowsiness to constipation urine retention to dry mouth.

Using more rigorous methods, a follow-up period extending beyond seven years, a more thorough assessment of pharmacy records regarding the medication use (both prescription and over-the-counter options), Dr. Gray's team was better able toconfirm this link between anticholinergic medication use and mental illness.

The pharmacy data allowed Dr. Gray and her team to calculate the standard daily medication doses of each study participant as well as their cumulative exposure to anticholinergics over a 10-year period. Over the course of the study, almost 800 participants developed a degree of dementia. The pharmacy data also revealed themost common medications (and daily doses) used by the group of participants: antidepressants (10 mg per day of doxepin), first-generation antihistamines (4mg per day of chlorpheniramine) and antimuscarinics for bladder control (5 mg per day of oxybutynin). They estimated that the use of such amounts for more than three years could result in a greater risk of developing dementia.

According to Dr. Gray, substitutes are available for the first two medications in this list. A selective serotonin re-uptake inhibitor like citalopram or fluoxitene can aide depression symptoms, while a second-generation antihistamine like loratadine can address allergies without the harmful, anticholinergic exposure. However, it can be more difficult to find an effective alternative for for urinary incontinence.

Dr. Gray hopes that this study will help inform older adults that many common medications have strong anticholinergic effects and come with a degree of risk when it comes to their mental health. However, for adults who are already taking drugs found to be problematic in this study, it's important to talk to your physician before terminating any medicinal regimen, as well as inform them of the over-the-counter drugs you take -- no matter how mainstream and benign they may seem.

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Medications for shift workers show little effectiveness

A review of medications shift workers take both for alertness and to help them sleep have little effectiveness.

Shift workers are taking drugs to help them stay awake or get to sleep despite weak evidence for their benefit, according to a new Cochrane review. The authors of the review found only small numbers of trials testing over-the-counter and prescription drugs used by shift workers, and the results suggest that for some people they might do more harm than good.

In most developed countries, at least 10% of the workforce is involved in some form of shift work. European statistics suggest that as many as three quarters of the population have 'non-standard' working hours. Disturbances to normal sleeping and waking patterns increase the risk of accidents and affect shift workers' health. It is therefore important to avoid shift work where possible and improve shift work schedules to help shift workers achieve more normal sleeping and waking patterns. In jobs where shift work cannot be avoided, such as health care, the police force or the military, drugs can potentially offer short-term benefits.

The review included 15 trials involving a total of 718 people. In nine trials, the over-the- counter hormone drug melatonin helped shift workers sleep for around 24 minutes longer during the night or day, compared to placebos. However, it did not help them get to sleep any quicker. Data from only one trial of the hypnotic drug zoplicone was available. The drug was no more effective than placebos for helping shift workers sleep during the day.

The remaining trials focused on caffeine and two drugs, modafinil and armodafinil, that are prescribed for sleepiness during night shifts. In one trial, caffeine reduced sleepiness during night shifts, when workers also napped before shifts. Modafinil and armodafinil, used by shift workers in one and two trials respectively, increased alertness and reduced sleepiness. However, they also caused headaches, nausea and a rise in blood pressure in a substantial number of people. Due to the limited benefits and frequent side effects, neither of these drugs is approved for shift workers in Europe.

"For lots of people who do shift work, it would be really useful if they could take a pill that would help them go to sleep or stay awake at the right time," said lead author of the review, Juha Liira, who is based at the Finnish Institute of Occupational Health in Helsinki, Finland. "But from what we have seen in our review, there isn't good evidence that these drugs can be considered for more than temporary use and some may have quite serious side effects."

Most of the data reported in the review was from small, low quality trials. In addition, trials tended to be carried out in specific settings, such as health care or oil rigs, so their results may be less relevant for workers in other types of roles.

"It's curious that there's such a clear gap in the research," said Liira. "It may well be that studying the effects of these drugs or others drugs in properly designed trials would be seen as unethical because workers should not need drugs to get along with their work. So the studies just haven't been done or if they have, our review has not been able to identify relevant data."

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CDC's report on sleeping pills

This article discusses the recent report by the CDC on sleep pill usage that showed 4% of adults have used sleep aids in the past month, that more older people use sleeping aids, and that more women than men use sleep aids.

A new study shows that many Americans continually look to sleep aids in order to get a good night's rest. In fact, around 4 percent of Americans use prescription sleep aids, according to the Centers for Disease Prevention and Control (CDC). Yet many still question the drug's side effects and effectiveness.

A national survey between 2005 and 2010 showed that about 4 percent of adults ages 20 and over reported taking prescription sleep aids in the past 30 days. Approximately 2 percent of the younger age group, 20 to 39, reported using sleeping pills, while 6 percent ranging in age from 50 to 59 reported using them. Ages 80 and up reported a 7 percent use.

The study showed that the rate of use also depended on gender, race and ethnicity. For instance, about 5 percent of women used prescription sleep aids compared to about 3 percent of men. While adults were also more likely to use sleep aids than black or Mexican-American men.

"More authorities think that use of sleeping pills should be minimized," said Dr. Daniel Kripke, professor emeritus of psychiatry at the University of California, San Diego, via Live Science.

Prescription sleep aids can be used as a treatment for those who have trouble falling asleep as many of the medications can work by suppressing activities in the nervous system. In fact, some estimates show that 50 to 70 million Americans suffer from sleep disorders or deprivation. This problem can greatly harm their daily function and may also adversely affect their health, according to CDC researchers.

Researchers looked at 33,000 people to find that the use of common sleep medications caused a greater risk of dying prematurely and even some type of cancer.

The CDC survey showed that when people slept for durations of greater or less than 7 hours, sleep aids use often increased. As for people who slept less than five hours a day, they were more likely to sleep nine hours a day and had the highest use of prescription sleep aid compared to those who reported getting seven hours a day.

Findings also showed that one in six people were diagnosed with a sleep disorder and up to one in eight reported problems with sleep. However, it's not clear whether the medications are effective at helping patients get a good night's rest or helping them feel refreshed in the morning.

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