Typology of Sleep Medication Users and Associated Mental Health and Substance Use from a Montreal Epidemiological Study

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Michel Perreault
Emma Mitchell
El Hadj Touré
Marie - Josée Fleury
Jean Caron


Sleep medication, mental health, typology, longitudinal model



Sleep medication is often reported as one of the most highly used psychotropic drugs in terms of past - year prevalence . Since their use often varies according to the characteristics of individuals, it is important to better understand these particular utilization patterns .


The study aims to develop a typology of sleep medication users ’ characteristics, including the ir associated mental health and substance use.


Residents from the epidemiological area of south - west Montreal , Quebec aged 15 years and older responded to a questionnaire in 2009 and 2011. Among the 1822 people who participated at both T1 and T2, 306 (17%) reported use of medication to help them sleep. These participants were selected for cluster analysis based on five variables related to mental health. The identified clusters were then tested for association with sociodemographic, psychosocial, and service use characteristics.


A three - cluster solution emerged: 1) older individuals without mental health problems, drug use or psychotropic medication use; 2) individuals with elevated psychological distress, drug use and low social support , and 3) individuals with mood and anxiety disorders, using services for mental health and taking two or more psychotropic medications.


The results establish the significance of problems related to mental health in differentiating sleep medication users. Consideration of these differences may improve the ability of health professionals to provide services that are better suited for patients, including interventions that increa se the ability to cope with stress (cluster 2) and more integrated services for those with concurrent disorders (cluster 3).

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1. Roth T. Prevalence, associated risks, and treatment patterns of insomnia. J Clin Psychiatry 2005 ; 9:10 - 3.
2. Léger D, Ohayon M, Beck F, Vecchierini M - F. Prévalence de l’insomnie: actualité épidémiologique. Médecine du Sommeil 2010;7(4):139 - 4 5.
3. Chong Y, Fryer CD, Gu Q. Prescription sleep aid use among adults: United States, 2005 - 2010. NCHS Data Brief Aug 2013 ; 127: 1 - 8.
4. IMS Institute for Healthcare Informatics. The use of medicines in the United States: Review of 2011. (April 2012) http://www.imshealth.com/ims/Global/Content/I nsights/IMS%20Institute%20for%20Healthcare %20Informatics/IHII_Medicines_in_U.S_Repor t_2011.pdf ( November 13, 2013).
5. Bélanger L, Vallières A, Morin CM. Insomnie et utilisation accrue de somnifères chez les aînés. Problématique et alternative de traitement 2006 ; 52:968 - 73.
6. Lesage A, Rhéaume J, Vasiliadis HM. Utilisation de services et consommation de médicaments liées aux problèmes de santé mentale chez les adultes québécois. Enquête sur la santé dans les collectivités canadiennes (cycle 1.2). Quebec: Institut de la statistique du Quebec 2008:53.
7. Kripke DF. Chronic hypnotic use: deadly risks, doubtful benefit. Sleep Med Rev 2000;4(1):5 - 20.
8. Kripke DF, Langer RD, Kline LE. Hypnotics' association with mortality or cancer: a matched cohort study. BMJ Open 2012;2(1).
9. Omvik S, Pallesen S, Bjorvatn B, Sivertsen B, Havik OE, Nordhus IH. Patient characteristics and predictors of sleep medication use. Int Clin Psychopharmacol 2010;25(2):91 - 100 .
10. Griffiths RR, Johnson MW. Relative abuse liability of hypnotic drugs: a conceptual framework and algorithm for differentiating among compounds. J Clin Psychiatry 2005;66 Suppl 9:31 - 41.
11. Mendelson WB, Roth T, Cassella J, et al. The treatment of chronic ins omnia: drug indications, chronic use and abuse liability. Summary of a 2001 New Clinical Drug Evaluation Unit meeting symposium. Sleep Med Rev Feb 2004;8(1):7 - 17.
12. Hyde M, Roehrs T, Roth T. Drugs of Abuse and Sleep. In: Lee - Chiong T, ed. Sleep: A Comprehens ive Handbook. Hoboken, NJ, USA: John Wiley & Sons, Inc. 2005:873 - 877.
13. McCabe SE, Cranford JA, West BT. Trends in prescription drug abuse and dependence, co - occurrence with other substance use disorders, and treatment utilization: results from two national surveys. Addict Behav Oct 2008;33(10):1297 - 305.
14. Goodwin RD, Hasin DS. Sedative use and misuse in the United States. Addiction 2002;97(5):555 - 62.
15. Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2011: National Estimates of Drug - Related Emergency Department Visits: HHS Publication No. (SMA) 13 - 4760 DAWN Series D - 39, Rockville, MD; 2013.
16. Glass J, Lanctôt KL, Hermann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta - analysis of risks and benefi ts. BMJ 2005;331(7526):1169.
17. Kassam A, Patten SB. Hypnotic use in a population - based sample of over thirty - five thousand interviewed Canadians. Popul Health Metr 2006(4):15.
18. Johnson EO, Roth T, Breslau N. The association of insomnia with anxiety disorders and depression: Exploration of the direction of risk. J Psychiatr Res 2006(40):700 - 8.
19. U.S. Food and Drug Administration. Medication guide: Ambien . (2013) http://www.fda.gov/downloads/drugs/drugsafety /ucm085906.pdf (September 5, 2013).
20. Jindal RD, Thase ME. Treatment of insomnia associated with clinical depression. Sleep Med Rev Feb 2004;8(1):19 - 30.
21. Clark RE, Xie H, Brunette MF. Benzodiazepine prescription practices and substance abuse in persons with severe mental illness. J Clin Psychiatry Feb 2004;65(2):15 1 - 5.
22. Vozoris NT, Leung RS. Sedative medication use: prevalence, risk factors, and associations with body mass index using population - level data. Sleep Jul 2011;34(7):869 - 74.
23. Fleury M - J, Grenier G, Bamvita J - M, Perreault M, Caron J. Typology of Adults Diagn osed with Mental Disorders Based on Socio - demographics and Clinical and Service Use Characteristics. BMC Psychiatry 2011;11 (1) :67.
24. Rubin WV, Panzano PC. Identifying meaningful subgroups of adults with severe mental illness. Psychiatr Serv 2002;53(4):452 - 7.
25. Casper ES, Donaldson B. Subgroups in the population of frequent users of inpatient services. Hosp Community Psychiatry1990;41(2):189 - 91.
26. Fisher S, Stevens RF. Subgroups of frequent users of an inpatient mental health program at a community hospital in Can ada. Psychiatr Serv1999;50(2):244 - 7.
27. Wainstein L, Victorri - Vigneau C, Sebille V, et al. Pharmacoepidemiological characterization of psychotropic drugs consumption using a latent class analysis. Int Clin Psychopharmacol Jan 2011;26(1):54 - 62.
28. Statistics Canada. National Population Health Survey (NPHS), Cycle 1 - 9: 2003 - 2005 Household Component - Longitudinal [Canada] [Microdata]. Ottawa, Ontario: Statistics Canada, Health Statistics Division [producer and distributor]. Ottawa, Ontario: Data Liberation Init iative [distributor] 2012.
29. Statistics Canada. Canadian Community Health Survey (CCHS) Cycle 1.2 - Derived Variable (DV) Specifications (2002). http://prod.library.utoronto.ca/datalib/codebooks /cstdli/cchs/cycle1_2_dummy/dvdoc_e.pdf. (September 1, 2013) .
30. Ke ssler R, Andrews G, Mroczek D, Ustun B, Wittchen H - U. The World Health Organisation Composite International Diagnostic Interview Short - Form (CIDISF). Int J Methods Psychiatr Res 1998;7:171 - 85.
31. Kessler R, Barker P, Colpe L, et al. Screening for serious ment al illness in the general population. Arch Gen Psychiatry 2003;60(2):184 - 9.
32. Burckhardt CS, Anderson KL. The Quality of Life Scale (QOLS): reliability, validity, and utilization. Health Qual Life Outcomes 2003;1:60.
33. Cutrona CE, Russell DW. The provisions of social support and adaptation to stress. In: Jones WH, Perlman D, eds. Advance in Personal Relationships . Vol 1. Greenwich, Conn.: JAI Press 1987:37 - 67.
34. Rapkin BD, Luke DA. Cluster analysis in community research: Epistemology and practice. Am J Community Psychol 1993;21(2):247 – 77.
35. Norusis MJ. Cluster Analysis. In: SPSS 19.0. Statistical Procedures Companion. Upper Saddle River, N.J.: Prentice Hall; 2011:375 - 404.
36. Turpide B, Joseph G. Qu e bec en forme vis ton énergie - Portrait sociodémographique, socioéconomique et scolaire de la région de Montréal . (24 mars 2006) http://www.centre123go.ca/upload/documents/6 2A2B479 - 2DA8 - 0507 - B71E - 33334FA113D1 - portrait_montreal_QEF.pdf (September 12, 201 3).
37. Vitiello MV, Larsen LH, Moe KE. Age - related sleep change: Gender and estrogen effects on the subjective - objective sleep quality relationships of healthy, noncomplaining older men and women. J Psychosom Res 2004;56(5):503.
38. Crowley K. Sleep and sleep disord ers in older adults. Neuropychol Rev 2011;21(1):41 - 53.
39. Mojtabai R, Olfson M. National trends in psychotropic medication polypharmacy in office - based psychiatry. Arch Gen Pyschiat 2010;67(1):26 - 36.
40. Chan - Cheea C, Bayonb V, Blocha J, Beckc F, Giordanellae J - P , Leger D. Épidémiologie de l’insomnie en France : état des lieux. Rev Epidémiol Santé 2011;59(6):409 - 22.
41. Fang SY, Chen CY, Chang IS, Wu EC, Chang CM, Lin KM. Predictors of the incidence and discontinuation of long - term use of benzodiazepines: A population - based study. Drug Alcohol Depend 2009;104(1 - 2):140 - 6.
42. Schubert CR, Cruickshanks KJ, Dalton DS, Klein BE, Klein R, Nondahl DM. Prevalence of sleep problems and quality of life in an older population. Sleep 2002;25(8):889 - 93.
43. Jansson M, Linton SJ. Psychological mechanisms in the maintenance of insomnia: arousal, distress, and sleep - related beliefs. Behav Res Ther Mar 2007;45(3):511 - 21.
44. O'Connor K, Belanger L, Marchand A, Dupuis G, Elie R, Boyer R. Psychological distress and adaptational problems ass ociated with discontinuation of benzodiazepines. Addict Behav 1999(24):537 – 41.
45. Kaneita Y, Uchiyama M, Takemura S, et al. Use of alcohol and hypnotic medication as aids to sleep among the Japanese general population. Sleep Med 2007(8):723 – 32.
46. Taylor SE, Sta nton AL. Coping resources, coping processes, and mental health. Annu Rev Clin Psychol 2007;3:377 - 401.
47. Caron J, Latimer E, Tousignant M. Predictors of psychological distress in low - income populations of Montreal. Can J Public Health Jul - Aug 2007;98 Suppl 1: S35 - 44.
48. Caron J, Liu A. Factors associated with psychological distress in the Canadian population: a comparison of low - income and non low - income sub - groups. Community Ment Health J Jun 2011;47(3):318 - 30.
49. Zhornitsky S, Potvin S, Moteshafi H, Dubreucq S, Rom pré PP, Stip E. Dose - response and comparative efficacy and tolerability of quetiapine across psychiatric disorders: a systematic review of the placebo - controlled monotherapy and add - on trials. Int Clin Psychopharmacol 2010;26(4):183 - 92.
50. Laurier C, Dumas J, Grégoire J - P, Duvak L. L'utilisation des tranquillisants, sédatifs et somnifères : analyse des données de l'enquête Santé Qu e bec 1987 Gouvernement du Qu e bec.
51. Morton LM, Cahill J, Hartge P. Reporting participation in epidemiologic studies: a survey of practice. Am J Epidemiol 2006;163:197 - 203.
52. Tooth L, Ware R, Bain C, Purdie DM, Dobson A. Quality of Reporting of Observational Longitudinal Research. Am J Epidemiol 2005;161(3):280 - 88.
53. Strom BL, (Ed.),. Pharmacoepidemiology, 4th edition : Wiley.com; 2005.