Epidemiology Of Alcohol and Medication As Aids To Sleep in Early Adulthood
SLEEP
Epidemiology Of Alcohol and Medication As Aids To Sleep in Early Adulthood
Eric O. Johnson 0 1
Timothy Roehrs 0 1
Thomas Roth 0 1
Naomi Breslau 0 1
0 Ford Health Sciences Center, Dept. of Psychiatry , 1 Ford Place, 3a, Detroit, MI 48202-3450 , USA
1 (1) Department of Psychiatry and the Sleep Disorder Center, Henry Ford Health Sciences Center, Detroit, Mich (2) Department of Psychiatry, Case Western Reserve University School of Medicine , Cleveland , Ohio (3) Department of Psychiatry, University of Michigan School of Medicine , Ann Arbor , Mich (4) Department of Psychiatry and Behavioral Neuroscience, Wayne State School of Medicine , Detroit, Mich , USA
Study objectives: In a representative sample of adults 18-45 years of age, this study addressed three questions about the use of sleep aids in the general population: (1) what are the past-year prevalences of the use of alcohol, over-the-counter medication and prescription medication to facilitate sleep? (2) among those who use these substances for sleep problems, what are the patterns of use? and (3) are there social factors, independent of sleep characteristics, that increase the likelihood of alcohol and medication use to aid sleep? Design: The 1996 Detroit Area Survey was a random-digit-dial, computer-assisted survey of a representative sample of 2,181 adults ages 18-45 in the Detroit primary metropolitan statistical area. Eligible household response rate was 86.8%. Results: In the general population, use of alcohol and medication as sleep aids in the past year was found to be fairly common: 13% used alcohol, 18% used medications and 5% used both. The prevalence of any substance use to aid sleep was 26%. The duration of use was short for the majority of users, less than 1 week. However, duration of use was greater for the majority of those using prescription sleep aids. A substantial minority of users report regular use lasting longer than 1 month: 15%, 9%, and 36% for alcohol, OTC medications, and prescription medications, respectively. Both sociodemographic and sleep characteristics were associated with alcohol and medication use to aid sleep. Difficulty falling asleep was the factor most strongly associated with use of substances to improve sleep. Sex, race/ethnicity, work shift, marital status and education were also significantly associated with one or more types of sleep aid use adjusting for difficulty falling asleep.
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EPIDEMIOLOGIC STUDIES of sleep disorders have
consistently reported high prevalence of severe insomnia in the
general population (10% to 17% ).1-5 However, information
about the use of substances to facilitate sleep is limited.
Prescription hypnotics, specifically the benzodiazepines,
have been the most frequently studied drugs used for the
treatment of insomnia. Consistent with the finding that the
majority of those with sleep difficulties do not consult a
doctor regarding their insomnia,2 the 12-month prevalence
Accepted for publication January, 1998
of benzodiazepine use in the US is fairly low,
approximately 3%.3 The low rates of treatment-seeking and
prescription hypnotic use compared to the prevalence of sleep
difficulties raises a question as to what degree alternative
substances are used to facilitate sleep. Only two population
based studiessponsored by the National Sleep
Foundationhave addressed this issue briefly.4,5 In those
studies, 22% to 29% of people with insomnia reported ever
having tried over-the-counter medications and 15% to 28%
had used alcohol specifically to help them sleep.4,5
Remaining important questions are these: (
1
) among
those who do use substances for perceived sleep problems,
what are the patterns of use? and (2) are there social factors,
independent of sleep characteristics, associated with use of
alcohol and medications to aid sleep?
Epidemiology of alcohol and medicationJohnson et al
Unweighted %
Weighted
%1
US Census
%2
Sex:
(
1
) Weights adjust estimates for sampling design and poststratification to Census characteristics
(2) US Bureau of the Census: Public use microdata sample - 1% sample (1990)
This study addressed these questions in a
representative community-based sample. Past-year prevalences of
alcohol and medication use (over-the-counter [OTC] and
prescription) as sleep aids were estimated. Patterns of use
were examined by the number of occasions and the
duration of alcohol and medication use. Finally, social and
sleep factors associated with the use of alcohol and
medication as sleep aids were assessed.
METHODS
Sample
The 1996 Detroit Area Survey collected information
from a representative sample of 2,181 respondents, ages 18
to 45, in the Detroit primary metropolitan statistical area
(PMSA). The survey employed random-digit dialing and
computer-assisted telephone interviewing techniques. Of
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the 6,110 households identified, 76.2% completed the age
and English-language screening; 64.1% of these included
an eligible respondent. One e (...truncated)