People are relying on sleeping pills more than ever to get a good night’s rest, but a new study by Scripps Clinic researchers links the medications to a 4.6 times higher risk of death and a significant increase in cancer cases among regular pill users.

The results, published on February 27 by the open-access online journal BMJ Open, cast a shadow over a growing segment of the pharmaceutical industry that expanded by 23 percent in the United States from 2006 to 2010 and generated about $2 billion in annual sales.

“What our study shows is that sleeping pills are hazardous to your health and might cause death by contributing to the occurrence of cancer, heart disease and other ailments,” said author Daniel F. Kripke, M.D., of the Viterbi Family Sleep Center in San Diego.

(View the paper here: http://press.psprings.co.uk/Open/february/bmjopen850.pdf)

The research is the first to show that eight of the most commonly used hypnotic drugs were associated with increased hazards of mortality and cancer, including the popularly prescribed medications zolpidem (known by the brand name Ambien) and temazepam (also known as Restoril), Dr. Kripke said. Those drugs had been thought to be safer than older hypnotics because of their shorter duration of action.

Study participants who took sleeping pills were matched with control patients of similar ages, gender and health who received no hypnotics in order to eliminate the possibility that other factors led to the results.

“We tried every practical strategy to make these associations go away, thinking that they could be due to use by people with more health problems, but no matter what we did the associations with higher mortality held,” said co-author Robert D. Langer, M.D., M.P.H., of the Jackson Hole Center for Preventive Medicine in Jackson, Wyoming.

Even among patients who were prescribed 1 to 18 sleeping pills per year, the risk of death was 3.6 times higher than among similar participants who did not take the medications. The study looked at patients aged 18 years and older, and found the increased risk in all age groups.

Rates of new cancers were 35 percent higher among patients who were prescribed at least 132 hypnotic doses a year as compared with those who did not take the drugs.

Using data stored in an electronic medical record that has been in place for more than a decade, the researchers obtained information on almost 40,000 patients cared for by a large integrated health system in the northeastern United States.

The study included 10,531 sleeping pill users who were prescribed the medications for an average of 2.5 years and 23,674 control participants who were not prescribed the drugs. Information came from outpatient clinic visits conducted between Jan. 1, 2002, and Sept. 30, 2006.

“It is important to note that our results are based on observational data, so even though we did everything we could to ensure their validity, it’s still possible that other factors explain the associations,” said co-author Lawrence E. Kline, D.O., who is medical director of the Viterbi Family Sleep Center. “We hope our work will spur additional research in this area using information from other populations.”

Funding for the study came from the Scripps Health Foundation and other philanthropic sources.

The BMJ Open report should prompt physicians to consider alternatives to hypnotic medications, Dr. Kline said.

Clinicians at the Viterbi Family Sleep Center focus on cognitive therapy that teaches patients to better understand the nature of sleep. For example, some people suffering from insomnia might require less than the eight hours of sleep commonly recommended for each night.

Patients also can benefit from practicing good sleeping habits and relaxation, as well as taking advantage of the body’s natural clock, which is driven by the rising and setting of the sun, Dr. Kline said. “Understanding how to use the circadian rhythm is a very powerful tool that doesn’t require a prescription,” he said.

When insomnia results from emotional problems such as depression, doctors should treat the psychological disorder rather than prescribe sleeping pills that could prove to be harmful, Dr. Kripke said.

About  Scripps Health

Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps Health is a $2.5 billion non-profit community healthcare system based in San Diego, Calif. Scripps treats a half-million patients annually through the dedication of 2,600 affiliated physicians and 13,000 employees among its five acute-care hospital campuses, home health care services, and an ambulatory care network of physician offices and 23 outpatient centers and clinics.

Scripps is also at the forefront of clinical research, genomic medicine, wireless health and graduate medical education. With three highly respected graduate medical education programs, Scripps is a longstanding member of the Association of American Medical Colleges. More information can be found at www.scripps.org.

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A survey published by the U.S. Center for Disease Control and Prevention (CDC) has studied the relation between mortality and the intake of sodium and potassium using a nationally representative. The study reveals that U.S. adults’ health is at risk.

According to it, a diet high in potassium and low in sodium reduces risk of death by a 50 percent. U.S. adults consume and average of 3,300 milligrams of sodium, more than twice the current recommended limit for most Americans. The results of the study show that a change in Americans’ diet is necessary to lower health risk.

The research was designed along with researchers from Emory University and Harvard University to assess the health and nutritional status of adults in the United States. As a result, findings show that people who reduce their sodium intake and increase their potassium consumption improved blood pressure and reduce risk for developing other serious health problems.

Elena Kuklina, M.D., Ph.D., an investigator on the study and a nutritional epidemiologist with the CDC’s Division for Heart Disease and Stroke Prevention said “the study provides further evidence to support current public health recommendations to reduce sodium levels in processed foods, given that nearly 80 percent of people’s sodium intake comes from packaged and restaurant foods. Increasing potassium intake may have additional health benefits.”

The 2010 Dietary Guidelines for Americans recommends that people choose more potassium-rich foods, advising 4,700 milligrams of potassium per day. The guide also suggests that healthy adults should limit sodium intake to 2,300 mg per day while individuals with high blood pressure should consume no more than 1,500 mg per day. For example table salt is 40 percent sodium; one teaspoon of table salt contains 2,300 mg of sodium.

Potassium, along with calcium and sodium, is an electrolyte important to the human nervous system, muscle function, fluid balance and heart, kidney and adrenal functions. However unlike sodium, potassium is naturally present in many fresh foods such as milk, vegetables and yogurt.  Processed meats, such as bacon, sausage, and ham and canned soups and vegetables are all examples of foods that contain added sodium. Fast food is generally very high in sodium.

Nutritionists recommend choosing smaller-sized servings. Consider splitting fast food meals to reduce the amount of calories and fat by asking for a “doggy bag” or simply leaving the excess on the plate. To help supplement and balance a fast food meal, choose nutritious options such as fresh fruits, vegetables and yogurt available as sides.

The Dietary Approaches to Stop Hypertension (DASH) diet advises eating more potassium and less sodium. It is recommended by the National Institutes of Health, which reminds people that variety and moderation are the key principles in providing a healthy diet for children as well as adults.

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