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January 1979, Vol 36, No. 1 >
Article | January 1979

Short and Long Sleep and Sleeping Pills: Title and subTitle BreakIs Increased Mortality Associated?

Daniel F. Kripke, MD; Ruth N. Simons; Lawrence Garfinkel, MA; E. Cuyler Hammond, ScD
[+] Author Affiliations

Accepted for publication Aug 29, 1978.

Reprint requests to Veterans Administration Medical Center (116), 3350 La Jolla Village Dr, San Diego, CA 92161 (Dr Kripke).


Arch Gen Psychiatry. 1979;36(1):103-116. doi:10.1001/archpsyc.1979.01780010109014
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Comments

• Prospective epidemiologic data of the American Cancer Society disclosed that reported usual sleep durations among groups who complained of insomnia and sleeping pill use "often" overlapped with those of groups who had no complaints. Reports of insomnia were not consistently associated with increased mortality when several factors were controlled; however, men who reported usually sleeping less than four hours were 2.80 times as likely to have died within six years as men who reported 7.0 to 7.9 hours of sleep. The ratio for women was 1.4.8. Men and women who reported sleeping ten hours or more had about 1.8 times the mortality of those who reported 7.0 to 7.9 hours of sleep. Those who reported using sleeping pills "often" had 1.5 times the mortality of those who "never" used sleeping pills. These results do not prove that mortality could be reduced by altering sleep durations or by reducing hypnotic prescribing. Rather, studies are needed to determine the causes of these mortality risk factors.

REFERENCES

1 +
Selected Symptoms of Psychological Distress, Public Health Service publication 1000. Series 11, No. 37. US Government Printing Office, 1970.
2 +
Cooper JR: Sedative-Hypnotic Drugs: Risks and Benefits, US Department of Health, Education, and Welfare publication (ADM) 78-592. US Government Printing Office, 1977.
3 +
Balter MB, Bauer ML:  Patterns of prescribing and use of hypnotic drugs in the United States , in Clift AD (ed): Sleep Disturbance and Hypnotic Drug Dependence . Amsterdam, Excerpta Medica, 1975;, pp 261-293.
4 +
Williams RL, Webb WB: Sleep Therapy . Springfield, Ill, Charles C Thomas Publisher, 1966;.
5 +
Ad Hoc Committee on Professional Standards Review Organizations: Model Criteria Sets . Washington, DC, American Psychiatric Association, 1974;.
6 +
Peer Review Committee of the American Psychiatric Association: Manual of Psychiatric Peer Review . Washington, DC, American Psychiatric Association, 1976;.
7 +
Greenblatt DJ, Miller RR:  Rational use of psychotropic drugs: I. Hypnotics . J Maine Med Assoc 65:192-197, 1974;.
8 +
Regestein QR:  Treating insomnia: A practical guide for managing chronic sleeplessness, circa 1975 . Compr Psychiatry 17:517-526, 1976;.
9 +
Hammond EC:  Smoking in relation to physical complaints . Arch Environ Health 3:146-164, 1961;.
10 +
Hammond EC:  Some preliminary findings on physical complaints from a prospective study of 1,064,004 men and women . Am J Public Health 54:11-23, 1964;.
11 +
Hammond EC:  Smoking in relation to the death rates of 1 million men and women . Natl Cancer Inst Monogr 19:127-204, 1966;.
12 +
Hammond EC, Garfinkel L:  Coronary heart disease, stroke, aortic aneurysm: Factors in the etiology . Arch Environ Health 19:167-182, 1969;.
13 +
Bickell PJ, Hammel EA, O'Connel JW:  Sex bias in graduate admissions: Data from Berkeley . Science 187:398-404, 1975;.
14 +
Mietlinen OS:  Standardization of risk ratios . Am J Epidemiol 96:383-388, 1972;.
15 +
Williams RL, Karacan I, Hursch CJ: Electroencephalography (EEG) of Human Sleep: Clinical Applications . New York, John Wiley & Sons Inc, 1974;.
16 +
Carskadon MA, Dement WC, Mitler MM, et al:  Self-reports versus sleep laboratory findings in 122 drug-free subjects with complaints of chronic insomnia . Am J Psychiatry 133:1382-1388, 1976;.
17 +
Frankel BL, Coursey RD, Buchbinder R, et al:  Recorded and reported sleep in chronic primary insomnia . Arch Gen Psychiatry 33:615-623, 1976;.
18 +
Kales A, Bixler E:  Sleep profiles of insomnia and hypnotic drug effectiveness , in Burch N, Altshuler HL (eds): Behavior and Brain Electrical Activity . New York, Plenum Press Inc, 1975;, pp 81-91.
19 +
Kales A, Allen C, Scharf MB, et al:  Hypnotic drugs and their effectiveness . Arch Gen Psychiatry 23:226-232, 1970;.
20 +
Kales A, Hauri P, Bixler E, et al:  Effectiveness of intermediate-term use of secobarbital . Clin Pharmacol Ther 20:541-545, 1976;.
21 +
Kales A, Kales JD, Bixler EO, et al:  Effectiveness of hypnotic drugs with prolonged use: Flurazepam and pentobarbital . Clin Pharmacol Ther 18:356-363, 1975;.
22 +
Kales A, Bixler EO, Tan T-L, et al:  Chronic hypnotic-drug use: Ineffectiveness, drug-withdrawal insomnia, and dependence . JAMA 227:513-517, 1974;.
23 +
Kales J, Tan T-L, Swearingen C, et al:  Are over-the-counter sleep medications effective? All-night EEG studies . Curr Ther Res 13:143-151, 1971;.
24 +
Feinberg I, Koresko RL, Heller N, et al: Sleep EEG and eyemovement patterns in young and aged normal subjects and in patients with chronic brain syndrome, in Proceedings of the Fourth World Congress of Psychiatry. International Congress Series 150, Amsterdam, Excerpta Medica, 1966, pp 2928-2930.
25 +
Kales A, Wilson T, Kales JD, et al:  Measurements of all-night sleep in normal elderly persons: Effects of aging . J Am Geriatr Soc 15:405-414, 1967;.
26 +
Kahn E, Fisher C:  The sleep characteristics of the normal aged male . J Nerv Ment Dis 148:477-494, 1969;.
27 +
Kales A, Caldwell AB, Preston TA, et al:  Personality patterns in insomnia . Arch Gen Psychiatry 33:1128-1134, 1976;.
28 +
Koranyi EK:  Fatalities in 2,070 psychiatric outpatients . Arch Gen Psychiatry 34:1137-1142, 1977;.
29 +
Sweetwood HL, Kripke DF, Grant I, et al:  Sleep disorder and psychobiological symptomatology in male psychiatric outpatients and male nonpatients . Psychosom Med 38:373-378, 1976;.
30 +
Belloc NB, Breslow L:  Relationship of physical health status and health practices . Prev Med 1:409-421, 1972;.
31 +
Belloc NB:  Relationship of health practices and mortality . Prev Med 2:67-81, 1973;.
32 +
Smolensky M, Halberg F, Sargent F II:  Chronobiology of the life sequence , in Ito S, Ogata K, Yoshimura H (eds): Advances in Climatic Physiology . Tokyo, Igaku Shoin, 1972;, pp 281-318.
33 +
Guilleminault C, Tilkian A, Dement WC:  The sleep apnea syndromes . Ann Rev Med 27:465-484, 1976;.
34 +
Guilleminault C, Eldridge FL, Phillips JR, et al:  Two occult causes of insomnia and their therapeutic problems . Arch Gen Psychiatry 33:1241-1245, 1976;.
35 +
Guilleminault C, Raynal D, Weitzman ED, et al:  Sleep-related periodic myoclonus in patients complaining of insomnia . Trans Am Neurol Assoc 100:19-22, 1975;.
36 +
Weitzman ED, Graziani L:  Sleep and the sudden infant death syndrome: A new hypothesis . Adv Sleep Res 1:327-344, 1974;.
37 +
Abelson J, Cohen R, Schrayer D, et al: Drug experience, attitudes, and related behavior among adolescents and adults, in Drug Use in America Appendix, publication 5266-00004. US Government Printing Office, 1973, vol 1, pp 488-867.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Selected Symptoms of Psychological Distress, Public Health Service publication 1000. Series 11, No. 37. US Government Printing Office, 1970.
2 +
Cooper JR: Sedative-Hypnotic Drugs: Risks and Benefits, US Department of Health, Education, and Welfare publication (ADM) 78-592. US Government Printing Office, 1977.
3 +
Balter MB, Bauer ML:  Patterns of prescribing and use of hypnotic drugs in the United States , in Clift AD (ed): Sleep Disturbance and Hypnotic Drug Dependence . Amsterdam, Excerpta Medica, 1975;, pp 261-293.
4 +
Williams RL, Webb WB: Sleep Therapy . Springfield, Ill, Charles C Thomas Publisher, 1966;.
5 +
Ad Hoc Committee on Professional Standards Review Organizations: Model Criteria Sets . Washington, DC, American Psychiatric Association, 1974;.
6 +
Peer Review Committee of the American Psychiatric Association: Manual of Psychiatric Peer Review . Washington, DC, American Psychiatric Association, 1976;.
7 +
Greenblatt DJ, Miller RR:  Rational use of psychotropic drugs: I. Hypnotics . J Maine Med Assoc 65:192-197, 1974;.
8 +
Regestein QR:  Treating insomnia: A practical guide for managing chronic sleeplessness, circa 1975 . Compr Psychiatry 17:517-526, 1976;.
9 +
Hammond EC:  Smoking in relation to physical complaints . Arch Environ Health 3:146-164, 1961;.
10 +
Hammond EC:  Some preliminary findings on physical complaints from a prospective study of 1,064,004 men and women . Am J Public Health 54:11-23, 1964;.
11 +
Hammond EC:  Smoking in relation to the death rates of 1 million men and women . Natl Cancer Inst Monogr 19:127-204, 1966;.
12 +
Hammond EC, Garfinkel L:  Coronary heart disease, stroke, aortic aneurysm: Factors in the etiology . Arch Environ Health 19:167-182, 1969;.
13 +
Bickell PJ, Hammel EA, O'Connel JW:  Sex bias in graduate admissions: Data from Berkeley . Science 187:398-404, 1975;.
14 +
Mietlinen OS:  Standardization of risk ratios . Am J Epidemiol 96:383-388, 1972;.
15 +
Williams RL, Karacan I, Hursch CJ: Electroencephalography (EEG) of Human Sleep: Clinical Applications . New York, John Wiley & Sons Inc, 1974;.
16 +
Carskadon MA, Dement WC, Mitler MM, et al:  Self-reports versus sleep laboratory findings in 122 drug-free subjects with complaints of chronic insomnia . Am J Psychiatry 133:1382-1388, 1976;.
17 +
Frankel BL, Coursey RD, Buchbinder R, et al:  Recorded and reported sleep in chronic primary insomnia . Arch Gen Psychiatry 33:615-623, 1976;.
18 +
Kales A, Bixler E:  Sleep profiles of insomnia and hypnotic drug effectiveness , in Burch N, Altshuler HL (eds): Behavior and Brain Electrical Activity . New York, Plenum Press Inc, 1975;, pp 81-91.
19 +
Kales A, Allen C, Scharf MB, et al:  Hypnotic drugs and their effectiveness . Arch Gen Psychiatry 23:226-232, 1970;.
20 +
Kales A, Hauri P, Bixler E, et al:  Effectiveness of intermediate-term use of secobarbital . Clin Pharmacol Ther 20:541-545, 1976;.
21 +
Kales A, Kales JD, Bixler EO, et al:  Effectiveness of hypnotic drugs with prolonged use: Flurazepam and pentobarbital . Clin Pharmacol Ther 18:356-363, 1975;.
22 +
Kales A, Bixler EO, Tan T-L, et al:  Chronic hypnotic-drug use: Ineffectiveness, drug-withdrawal insomnia, and dependence . JAMA 227:513-517, 1974;.
23 +
Kales J, Tan T-L, Swearingen C, et al:  Are over-the-counter sleep medications effective? All-night EEG studies . Curr Ther Res 13:143-151, 1971;.
24 +
Feinberg I, Koresko RL, Heller N, et al: Sleep EEG and eyemovement patterns in young and aged normal subjects and in patients with chronic brain syndrome, in Proceedings of the Fourth World Congress of Psychiatry. International Congress Series 150, Amsterdam, Excerpta Medica, 1966, pp 2928-2930.
25 +
Kales A, Wilson T, Kales JD, et al:  Measurements of all-night sleep in normal elderly persons: Effects of aging . J Am Geriatr Soc 15:405-414, 1967;.
26 +
Kahn E, Fisher C:  The sleep characteristics of the normal aged male . J Nerv Ment Dis 148:477-494, 1969;.
27 +
Kales A, Caldwell AB, Preston TA, et al:  Personality patterns in insomnia . Arch Gen Psychiatry 33:1128-1134, 1976;.
28 +
Koranyi EK:  Fatalities in 2,070 psychiatric outpatients . Arch Gen Psychiatry 34:1137-1142, 1977;.
29 +
Sweetwood HL, Kripke DF, Grant I, et al:  Sleep disorder and psychobiological symptomatology in male psychiatric outpatients and male nonpatients . Psychosom Med 38:373-378, 1976;.
30 +
Belloc NB, Breslow L:  Relationship of physical health status and health practices . Prev Med 1:409-421, 1972;.
31 +
Belloc NB:  Relationship of health practices and mortality . Prev Med 2:67-81, 1973;.
32 +
Smolensky M, Halberg F, Sargent F II:  Chronobiology of the life sequence , in Ito S, Ogata K, Yoshimura H (eds): Advances in Climatic Physiology . Tokyo, Igaku Shoin, 1972;, pp 281-318.
33 +
Guilleminault C, Tilkian A, Dement WC:  The sleep apnea syndromes . Ann Rev Med 27:465-484, 1976;.
34 +
Guilleminault C, Eldridge FL, Phillips JR, et al:  Two occult causes of insomnia and their therapeutic problems . Arch Gen Psychiatry 33:1241-1245, 1976;.
35 +
Guilleminault C, Raynal D, Weitzman ED, et al:  Sleep-related periodic myoclonus in patients complaining of insomnia . Trans Am Neurol Assoc 100:19-22, 1975;.
36 +
Weitzman ED, Graziani L:  Sleep and the sudden infant death syndrome: A new hypothesis . Adv Sleep Res 1:327-344, 1974;.
37 +
Abelson J, Cohen R, Schrayer D, et al: Drug experience, attitudes, and related behavior among adolescents and adults, in Drug Use in America Appendix, publication 5266-00004. US Government Printing Office, 1973, vol 1, pp 488-867.

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