title: Prevalence and Predictors of Prescription Sleep Aid Use among Individuals with DSM-5 Insomnia: The Role of Hyperarousal.
abstract: OBJECTIVE
  Despite mounting evidence for the overuse of prescription sleep aids (PSA), reliable data on PSA use among insomniacs are unavailable. Current studies focus on trends in PSA use at the general population level, and thus do not distinguish between transient sleep disturbance and insomnia disorder. Therefore, we prospectively examined the prevalence and predictors of baseline and chronic PSA use in a well-defined sample of individuals with insomnia.
  
  
  METHODS
  We analyzed longitudinal data from an urban, community-based cohort of 649 adults (48.1 ± 11.6 y; 69.3% female) with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-based insomnia disorder. Participants completed standardized measures of sleep disturbance, daytime alertness, depression, and anxiety at baseline and follow-up 1 y later. They also reported whether and with what frequency they used PSA at both time points.
  
  
  RESULTS
  Approximately 19% of the sample used PSA at baseline, the majority (69.4%) of whom continued use 1 y later. Anxiety and daytime alertness were the only independent predictors of both acute and chronic PSA use. An increase of 1 standard deviation (SD) in alertness was associated with a 33% increase in the odds of chronic PSA use (χ(2) = 4.98; odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.04-1.72; P < 0.05), and a 1-SD increase in anxiety was associated with a 41% increase (χ(2) = 6.95; OR = 1.41; 95% CI: 1.09-1.82; P < 0.05). Chronic PSA users did not report any significant improvements in sleep from baseline to follow-up relative to nonusers.
  
  
  CONCLUSIONS
  Hyperarousal, as indexed by daytime alertness and anxiety, is a strong determinant of PSA use among individuals with insomnia. These findings are consistent with emerging data showing that insomnia is not just a nocturnal sleep disorder, but one characterized by 24-h arousal. Though current research targets sleep disturbance, this study highlights the role of the arousal system in pharmacological treatment seeking.
authors.affiliation: Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.
authors.forename: Vivek
authors.initials: V
authors.lastname: Pillai
authors.affiliation: Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.
authors.forename: Philip
authors.initials: P
authors.lastname: Cheng
authors.affiliation: Sleep and Circadian Research Laboratory, University of Michigan, Ann Arbor, MI.
authors.forename: David A
authors.initials: DA
authors.lastname: Kalmbach
authors.affiliation: Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.
authors.forename: Timothy
authors.initials: T
authors.lastname: Roehrs
authors.affiliation: Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.
authors.forename: Thomas
authors.initials: T
authors.lastname: Roth
authors.affiliation: Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Drake
mesh_terms: D001007:Anxiety; D001143:Arousal; D001288:Attention; D003863:Depression; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D055656:Prescriptions / Q000706:statistics & numerical data*; D015995:Prevalence; D012890:Sleep; D000068776:Sleep Aids, Pharmaceutical / Q000008:administration & dosage / Q000627:therapeutic use*; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D014504:Urban Health / Q000706:statistics & numerical data
chemical_list: D000068776:Sleep Aids, Pharmaceutical
keywords: alertness; anxiety; hyperarousal; insomnia; prescription sleep aids