Hypnotic Use Not Linked to Increased Risk of Mild Cognitive Impairment or Dementia: Study
USA: Findings presented at the SLEEP 2026 conference, held in Baltimore from June 14–17, 2026, suggest that the use of hypnotic medications is not associated with an increased risk of developing incident mild cognitive impairment (MCI) or dementia. The study findings, published subsequently in the Sleep journal, provide reassurance regarding the cognitive safety of hypnotic use, indicating that these medications do not appear to contribute to the onset of cognitive decline or dementia in the studied population.
Previous observational studies have suggested that hypnotic medications may increase the risk of cognitive decline. However, these associations may have been influenced by factors such as insomnia severity, psychiatric illness, healthcare utilization, and other medical conditions rather than the medications themselves. To address these potential confounders, the researchers evaluated whether hypnotic use independently affects the risk of developing MCI or dementia after extensive statistical adjustment.
For this purpose, Bhanu Kolla from Mayo Clinic and colleagues conducted a retrospective cohort study using a biobank linked to electronic health records and genetic data. The study included 27,055 individuals without hypnotic exposure and 11,456 hypnotic users classified by prescription frequency, duration, and drug class, including benzodiazepines, Z-drugs, trazodone, and mixed exposure. The primary outcome was incident mild cognitive impairment (MCI) or dementia occurring at least 12 months after the initial prescription. Analyses adjusted for propensity scores, cardiovascular risk, healthcare utilization, psychiatric and sleep-related conditions, alcohol use, chronic pain, and Apolipoprotein E ε4 status.
Initially, unadjusted analyses suggested a slight increase in the risk of MCI or dementia among hypnotic users compared with non-users. However, after adjusting for clinical characteristics, healthcare utilization, and genetic risk, hypnotic use was associated with a significantly lower risk of developing MCI or dementia.
Key findings
- After comprehensive adjustment, hypnotic users had a significantly lower risk of incident MCI or dementia than non-users.
- Reduced risk was observed among users of Z-drugs, trazodone, and individuals exposed to multiple hypnotic classes.
- Long-term hypnotic use was associated with a lower risk of MCI or dementia than no hypnotic use, a single prescription, or short-term use.
- Benzodiazepine-only users did not demonstrate the same apparent benefit as other hypnotic classes.
The researchers concluded that the previously reported association between hypnotic use and cognitive decline is likely explained by underlying clinical factors rather than the medications themselves. After rigorous adjustment for potential confounders, hypnotic use was not associated with an increased risk of MCI or dementia, and several hypnotic classes were linked to a lower risk. They noted that further research is needed to determine whether certain hypnotics may have protective effects against cognitive decline.
Reference:
Kolla, B., Gugliotta, A., Mansukhani, M., Coombes, B., Carvalho, D., Sambataro, F., & Vemuri, P. (2026). 0429 Hypnotic Use Does Not Increase the Risk of Incident Mild Cognitive Impairment/Dementia: A Retrospective Cohort Study. Sleep, 49(Supplement_1), A191. https://doi.org/10.1093/sleep/zsag091.0429
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