REVIEW OF: Tam K et al, Sleep Medicine 2026;143:108895
STUDY TYPE: Cross-sectional, nationally representative US cohort
EVIDENCE GRADE: Low (3/10)
Sedative misuse is often framed as a problem of the disadvantaged, but the data point in other directions. This study used 2021–2023 National Survey on Drug Use and Health data from over 138,000 adults to map who is misusing sedatives for sleep.
About 0.27% of US adults — roughly 681,000 people — reported misusing sedatives for sleep. The profile of that group cuts two ways. Higher income, more education, and White (non-Hispanic) race were all associated with greater misuse, consistent with better access to prescriptions. College graduates had about twice the relative risk of misuse compared to high school graduates. At the same time, misuse was also elevated among those with chronic health conditions, poor mental health, a history of incarceration, and same-sex attraction — groups more likely driven by unmet sleep need rather than access.
Practice Implications
- With greater wealth comes greater access to controlled substances, a trend we also see with amphetamine-benzo combinations. But access only explains some of the misuse here.
- Sleep medications are intended as a short-term solution, a way to restore biological rhythms that have drifted off course. In most trials, patients notice no difference when their sleep med is replaced with a placebo after 1-2 months.
- Discuss an end date when prescribing sleep meds, and add behavioral strategies like CBT-insomnia from the start (also available as an app).
Share Your Input in Comments
- Which sleep meds have you seen misused in practice?
- What are your tips for keeping them short-term?
