Certain sleeping pills may increase risk of pneumonia

Benzodiazepines (BZD) are an older class of medicines that have been used for insomnia - examples include Restoril and Valium. Here is a study that links BZD use to pneumonia in a UK community. I don't have access to the full article, but another review of the article says that researchers think the BZDs may reduce immunity. I was not aware of that - I would think that BZDs could increase pneumonia risk because they may suppress drive to breathe, especially when combined with other sedating medications and alcohol.

Sleeping pills do not always work for insomnia

This article discusses a survey done in the UK showing that 4 out of 10 people said sleeping pills do not help their insomnia.

Sleep Aids, Mortality, and Cancer

In the British Medical Journal is a study that has received a lot of attention in the press. In this study, the authors looked at over 200,000 patients in Geisenger's Health System, including those who did and did not use sleep aids. Their analyses showed that those that took any type of sleep aid had a significantly higher chance of dying compared to those who did not take sleep aids. And the data showed that the risk of dying was still higher in sleep aid users when controlling for underlying diseases known to increase death, like heart and lung disease. There was also an increased risk of cancer in those that took sleep aids compared to those that did not.

The researchers speculate that increased death rates may occur with sleep aid use because some sleeping pills are lethal if too much is taken at once or if combined with other drugs or alcohol. Some sleep aids increase risk of depression which could lead to suicides. Sleep aids, especially in the elderly, can increase risk of car crashes and falls. Some sleep aids can worsen underlying sleep apnea, which already has a higher mortality rate.

Sleeping Pills and Death Risk

In the September issue of the Canadian Journal of Psychiatry, a study was performed to assess the mortality risk associated with sleeping pills and anti-anxiety medications. The study involved over 14,000 people aged 18 to 102 who participated in the National Population Health Survey in Canada between 1994 and 2007. Every two years, participants were asked if they used sleeping pills or anti-anxiety medications in the past month.

The overall mortality rate for the entire population was 11.55%. In respondents who took sleeping pills or anti-anxiety pills, the rate was 15.56%. In respondents who said they did not take sleeping pills or anti-anxiety medications, the mortality rate was 10.52%.

After controlling for other factors like alcohol and tobacco use, physical health, physical activity level, and the presence of depression, the mortality rate was still slightly higher in those participants who reported they took sleeping pills or anti-anxiety medications.

The study authors proposed different explanations. Benzodiazepines like Valium could impair reaction time, coordination, alertness, and memory, which then could lead to falls and other accidents. Benzodiazepines could also depress the respiratory system, which could aggravate sleep-related breathing disorders.

Limitations of the study include the fact that medication use was assessed using only two questions. There was no control for the presence of anxiety disorders, whereas the study did control for depression. Also, self-reported data like this survey can introduce a number of biases.

The authors recommend that physicians consider alternative, non-pharmacological treatment of insomnia and anxiety, like cognitive-behavioral therapy, a form of psychotherapy.