Impact of Non-Benzodiazepine Sleeping Pills on Falls and Fractures
Introduction to Sleeping Pills and Insomnia
Sleeping pills are frequently prescribed to address insomnia, a condition that adversely affects an individual’s quality of life. Hypnotic medications, known as sleeping pills, are typically recommended by healthcare professionals to facilitate easier sleep onset.
Types of Sleeping Pills
Modern sleeping pills fall into two main categories. The older category includes benzodiazepines, such as temazepam, while the newer category comprises non-benzodiazepines, such as zolpidem. Both categories can lead to daytime drowsiness and reduced alertness. Previous studies have indicated that benzodiazepines are associated with a heightened risk of falls and bone fractures, leading many doctors to consider non-benzodiazepine sleeping pills as a safer alternative, resulting in their rise as the most commonly prescribed sleeping aids.
Research on Non-Benzodiazepines and Fall Risks
Numerous clinical studies have aimed to determine whether non-benzodiazepines contribute to an increased risk of falls and fractures. The findings have been inconsistent, with some studies reporting an elevated risk while others do not. Researchers in Israel conducted a comprehensive analysis of these studies, compiling results to provide clearer insights, with their findings published in the journal Age and Ageing.
Study Methodology and Findings
The researchers identified all prior studies comparing fall or fracture rates between adults using non-benzodiazepine sleeping pills and those not using these medications. They reviewed 14 studies, encompassing data from over a million individuals.
Bone Fracture Risk
By consolidating data from ten studies with 830,877 participants, the researchers discovered that adults using non-benzodiazepines were 1.6 times more likely to experience a bone fracture compared to those not taking these medications. While various non-benzodiazepines were included in these studies, only zolpidem had sufficient data for individual analysis. It was found that participants using zolpidem had a 1.4-fold increased risk of fractures.
Older Adults and Fracture Risk
Given that older adults face a higher risk of falls and fractures, the researchers specifically analyzed studies involving participants aged 65 and above. Their findings indicated that older adults using non-benzodiazepines were 1.7 times more likely to sustain a fracture compared to their counterparts not using these drugs.
Injury Risks Associated with Zolpidem
Only two studies evaluated the overall injury risk related to zolpidem use. These studies included 160,502 participants and revealed that those taking zolpidem were twice as likely to incur injuries compared to those not taking the medication.
Potential Causes of Increased Fall Risks
Patients using sleeping pills may experience drowsiness and diminished alertness, making them more prone to falls. The researchers identified three studies, comprising 19,505 participants, that examined whether adults using non-benzodiazepines were at a greater risk of falling. While a tendency for increased fall risk was noted, the variation in results across these studies led to uncertainty regarding the strength of the connection.
Need for Further Research
The researchers emphasized the necessity for additional studies to explore the relationship between non-benzodiazepine sleeping pills and fall risks. Accurately assessing fall incidents is challenging, as it often relies on self-reported data, which can be influenced by participants’ memory and perceptions. In contrast, injury and fracture data can be objectively verified through medical records.
Limitations of Current Research
Several limitations were noted in the studies reviewed. Notably, many did not account for factors such as age and gender, both of which significantly impact osteoporosis risk. Furthermore, none of the studies directly compared non-benzodiazepines with benzodiazepines.
Conclusion and Recommendations
Overall, the researchers concluded that adults using non-benzodiazepine sleeping pills face an increased risk of bone fractures and injuries, alongside a probable heightened risk of falls. They advise healthcare providers to consider these risks when prescribing these medications, particularly for older patients already vulnerable to falls and injuries. There is a pressing need for further studies to clarify the association between non-benzodiazepine sleeping pills and fall risks.
Reference
Treves, N., Perlman, A., Kolenberg Geron, L., Asaly, A. & Matok, I. Z-drugs and risk for falls and fractures in older adults—a systematic review and meta-analysis. Age and Ageing 47, 201-208 (2018).