Prescription medications for sleep disturbances among midlife women during 2 years of follow-up: a SWAN retrospective cohort study

BMJ Open. 2021 May 11;11(5):e045074. doi: 10.1136/bmjopen-2020-045074.


Objective: To examine the effects of prescription sleep medications on patient-reported sleep disturbances.

Design: Retrospective cohort.

Setting: Longitudinal cohort of community-dwelling women in the USA.

Participants: Racially and ethnically diverse middle-aged women who reported a sleep disturbance.

Interventions: New users of prescription sleep medications propensity score matched to women not starting sleep medications.

Main outcomes and measures: Self-reported sleep disturbance during the previous 2 weeks-difficulty initiating sleep, waking frequently and early morning awakening-using a 5-point Likert scale, ranging from no difficulty on any night (rating 1) to difficulty on 5 or more nights a week (rating 5). Sleep disturbances were compared at 1 year (primary outcome) and 2 years of follow-up.

Results: 238 women who started sleep medications were matched with 447 non-users. Participants had a mean age of 49.5 years and approximately half were white. At baseline, sleep disturbance ratings were similar: medication users had a mean score for difficulty initiating sleep of 2.7 (95% CI 2.5 to 2.9), waking frequently 3.8 (95% CI 3.6 to 3.9) and early morning awakening 2.8 (95% CI 2.6 to 3.0); non-users ratings were 2.6 (95% CI 2.5 to 2.7), 3.7 (95% CI 3.6 to 3.9) and 2.7 (95% CI 2.6 to 2.8), respectively. After 1 year, ratings for medication users were 2.6 (95% CI 2.4 to 2.8) for initiating sleep, 3.6 (95% CI 3.4 to 3.8) for waking frequently and 2.8 (95% CI 2.6 to 3.0) for early morning awakening; for non-users, the mean ratings were 2.3 (95% CI 2.2 to 2.5), 3.5 (95% CI 3.3 to 3.6) and 2.5 (95% CI 2.3 to 2.6), respectively. None of the 1 year changes were statistically significant nor were they different between medication users and non-users. Two-year follow-up results were consistent, without statistically significant reductions in sleep disturbance in medication users compared with non-users.

Conclusions: These analyses suggest that women who initiated sleep medications rated their sleep disturbances similar after 1 and 2 years. The effectiveness of long-term sleep medication use should be re-examined.

Keywords: epidemiology; sleep medicine; therapeutics.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cohort Studies
  • Female
  • Humans
  • Middle Aged
  • Prescriptions
  • Retrospective Studies
  • Sleep
  • Sleep Wake Disorders* / drug therapy