Sleep Aid Use Research Articles

Use of Pharmacologic Sleep Aids and Stimulants Among Emergency Medicine Staff Physicians in a Canadian Tertiary Care Setting: A Web-Based Survey

Emergency medicine by its nature requires shift work that follows an erratic and unpredictable pattern. Faced with thischallenge, we hypothesize that many emergency physicians have taken steps to minimize their personal sleep deprivation through the use of pharmacologic sleep aids. The extent and nature of pharmacologic sleep aid use in this population is not well studied. We seekto describe the use of pharmacologic sleep aids among practicing emergency physicians in a Canadian tertiary care setting. A cross-sectional descriptive Web-based survey was sent by e-mail to all practicing staff emergency physicians within the Calgary zone of Alberta Health Services. Descriptive statistics were used to assess frequencies and explore associations between selected variables. Of the 198 eligible emergency physicians, 144 (73%) completed the survey. Ninety-six emergency physicians (67%; 95% confidence interval [CI] 59% to 74%) had used a pharmacologic sleep aid at some time in their career, and 81 (56%; 95% CI 48% to 64%) were currently using one with any frequency. The most frequent sleep aids being used by physician respondents were nonbenzodiazepine hypnotics (38%), alcohol (17%), and melatonin (15%). Sixty-five respondents (45%; 95% CI 37% to 53%) required a prescription for their pharmacologic sleep aid and 38 (58%; 95% CI 46% to 70%) of those had obtained a prescription from an emergency physician colleague. None of the physicians believed that their use of pharmacologic sleep aids adversely affected their ability to provide quality patient care. Pharmacologic sleep aid use among Canadian emergency physicians may be more common than previously assumed. This could have implications for physician well-being and performance.

Sleep Disorders and Symptoms in Blacks with Metabolic Syndrome: the Metabolic Syndrome Outcome Study (MetSO)

Sleep disturbance is a major public health issue and is comorbid with the cluster of conditions associated with metabolic syndrome (MetS). Our study explored the presence of sleep disturbance, including daytime sleepiness, the risk for obstructive sleep apnea (OSA), and insomnia symptoms, in a cohort of adult Black men and women with MetS. Patients (n=1,013) from the Metabolic Syndrome Outcome Study (MetSO), 2009-2012, met criteria for MetS based on guidelines from the National Cholesterol Education Program's Adult Treatment Panel and provided sociodemographic data and the Apnea Risk Evaluation System (ARES) questionnaire to assess OSA risk, sleep characteristics, and physician-reported diagnosis of a sleep disorder. Prevalence of the components of MetS included: diabetes (60%); obesity (67%); hypertension (94%); and dyslipidemia (74%). Based on the ARES, 49% were at risk for OSA. Of all study patients, slightly more than half (53%) reported feeling sleepy during the day, and 10% reported an insomnia diagnosis. The most common sleep disturbance reported by 46% of the patients was early morning awakenings (EMA). This was closely followed by 42% who reported difficulty staying asleep (DSA) and 38% reporting difficulty falling asleep (DFA). Seventy percent reported short sleep (≤ 6 hours), whereas a minority (19%) reported long sleep (≥ 9 hours). Only 12% used sleep aids. Women, compared with men, reported greater daytime sleepiness, greater DFA, and greater DSA (57% vs 45%; 41% vs 32.4%; 45% vs 37%), respectively. Blacks with MetS reported insomnia symptoms and insomnia disorder, use of sleep aids, feeling sleepy during the day, and inadequate sleep durations. The presence of these sleep characteristics suggests that patients with MetS should be referred for further sleep assessment.

Patterns of benzodiazepines use in primary care adults with anxiety disorders

BackgroundBenzodiazepines are among the most commonly prescribed drugs for anxiety disorders. While they are indicated as adjunctive treatment for short-term use according to clinical practice guidelines, previous studies have shown patterns of long-term use of benzodiazepines, which is problematic due to side effects, dependence and potential of abuse. The aims of this study were to examine among a large sample of primary care adults suffering from anxiety disorders: 1) benzodiazepine use patterns; and 2) correlates of long-term benzodiazepine use. MethodsData were drawn from the “Dialogue” project, a large primary care study conducted in 64 primary care clinics in the province of Quebec, Canada. Following a mental health screening in waiting rooms, patients at risk of anxiety or depression completed the Composite International Diagnostic Interview-Simplified (CIDIS). A sample of 740 adults meeting DSM-IV criteria for Generalized Anxiety Disorder, Panic Disorder or Social Anxiety Disorder in the past 12 months took part in this study. ResultsBenzodiazepines were used by 22.6% of participants with anxiety disorders in our primary care sample. A large majority of benzodiazepine users (88.4%) met our indicator of long-term use, as defined by utilization for more than 12 weeks including regular and as-needed use. Based on a logistic regression model, individual correlates associated with long-term benzodiazepine use included: being 30 years or older, having a comorbid physical illness, meeting criteria for comorbid agoraphobia, reporting the use of sleep-aids, and concurrent SSRI utilization. LimitationData collection with self-reported questionnaires may be subject to information bias. ConclusionsDespite knowledge of the risks of long-term use of benzodiazepines, this remains a pervasive problem. Clinicians need to be mindful of patterns and risk factors leading to long-term use of benzodiazepines in patients with anxiety disorders. Results of this study should raise awareness regarding appropriate prescription practices for benzodiazepines, including decision-making in initiation, duration of prescription, and use of strategies for discontinuation in current long-term benzodiazepine users.

The association of sleep duration and quality with all-cause and cause-specific mortality in the Women’s Health Initiative

Background/ObjectiveMany studies have shown a U-shaped association of sleep duration with mortality; however, this association is difficult to interpret owing to possible reverse causation, residual confounding, and measurement issues. We used data from the Women's Health Initiative to examine the associations of sleep duration, insomnia, and use of sleep aids with death from cardiovascular disease (CVD), cancer, “other” causes, and all causes combined. MethodsCox proportional hazards models were used in the analysis of baseline data and in time-dependent analyses of repeated measures to estimate associations of sleep-related factors with mortality. Among 158,203 women with information regarding sleep, 30,400 total deaths, 8857 CVD deaths, 9284 cancer deaths, and 11,928 other deaths were ascertained over a median of 17.8 years. ResultsIn both baseline and time-dependent analyses, both short (≤5 h) and long sleep (≥9 h) durations were associated with increased risk of total, CVD, and “other” deaths, but not with cancer deaths. Insomnia showed no association with mortality, whereas use of sleep medications was associated with an increased mortality risk. ConclusionsWhile our findings showed a small but robust association of sleep duration with mortality in postmenopausal women, studies including objective measurements of sleep quality and efficiency are needed to clarify these associations.

Pharmacologic Treatment of Sleep Disorders in Pregnancy.

Pregnancy often predisposes women to new-onset sleep disturbances, as well as exacerbations of preexisting sleep disorders. The goals of treating perinatal sleep disorders include the promotion of restorative sleep and the benefits it brings to both mother and fetus. The prescribing of any sleep aid in pregnancy must include consideration of the risks and benefits for both the patient and her fetus. Although data on the perinatal use of sleep aids is limited, there may be effects on fetal development, timing and duration of delivery, and postnatal outcomes.

Relationships between self-reported sleep quality components and cognitive functioning in breast cancer survivors up to 10years following chemotherapy.

Links have been made between aspects of sleep quality and cognitive function in breast cancer survivors (BCS), but findings are heterogeneous. The objective of this study is to examine relationships between specific sleep quality components (latency, duration, efficiency, daytime sleepiness, sleep disturbance, use of sleep aids) and cognitive impairment (performance and perceived), and determine which sleep quality components are the most significant contributors to cognitive impairments in BCS 6months to 10years post chemotherapy. Women 21 to 65years old with a history of non-metastatic breast cancer following chemotherapy completion were recruited. Data collection included surveys to evaluate sleep quality and perceived cognitive impairments, and neuropsychological testing to evaluate verbal fluency and memory. Descriptive statistics, bivariate correlations, and hierarchical multiple regression were calculated. Ninety women (mean age 49) completed data collection. Moderate significant correlations were found between daytime dysfunction, sleep efficiency, sleep latency, and sleep disturbance and perceived cognitive impairment (Rs=-0.37 to -0.49, Ps<.00049), but not objective cognitive performance of verbal fluency, memory, or attention. After accounting for individual and clinical characteristics, the strongest predictors of perceived cognitive impairments were daytime dysfunction, sleep efficiency, and sleep disturbance. Findings support links between sleep quality and perceived cognitive impairments in BCS and suggest specific components of sleep quality (daytime dysfunction, sleep efficiency, and sleep disturbance) are associated with perceived cognitive functioning in this population. Findings can assist clinicians in guiding survivors to manage sleep and cognitive problems and aid in the design of interventional research.

Night shift preparation, performance, and perception: are there differences between emergency medicine nurses, residents, and faculty?

ObjectiveDetermine differences between faculty, residents, and nurses regarding night shift preparation, performance, recovery, and perception of emotional and physical health effects.MethodsSurvey study performed at an urban university medical center emergency department with an accredited residency program in emergency medicine.ResultsForty-seven faculty, 37 residents, and 90 nurses completed the survey. There was no difference in use of physical sleep aids between groups, except nurses utilized blackout curtains more (69%) than residents (60%) and faculty (45%). Bedroom temperature preference was similar. The routine use of pharmacologic sleep aids differed: nurses and residents (both 38%) compared to faculty (13%). Residents routinely used melatonin more (79%) than did faculty (33%) and nurses (38%). Faculty preferred not to eat (45%), whereas residents (24%) preferred a full meal. The majority (>72%) in all groups drank coffee before their night shift and reported feeling tired despite their routine, with 4:00 a.m. as median nadir. Faculty reported a higher rate (41%) of falling asleep while driving compared to residents (14%) and nurses (32%), but the accident rate (3% to 6%) did not differ significantly. All had similar opinions regarding night shift-associated health effects. However, faculty reported lower level of satisfaction working night shifts, whereas nurses agreed less than the other groups regarding increased risk of drug and alcohol dependence.ConclusionFaculty, residents, and nurses shared many characteristics. Faculty tended to not use pharmacologic sleep aids, not eat before their shift, fall asleep at a higher rate while driving home, and enjoy night shift work less.

Self-Medication for Sleep in College Students: Concurrent and Prospective Associations With Sleep and Alcohol Behavior

ABSTRACTObjective/Background: College students are at an increased risk for poor sleep and associated sleep problems. Emerging evidence suggests that a substantial subset of college students self-medicate with alcohol, marijuana, or over-the-counter medications to help sleep. The current study identified demographic, psychosocial, and sleep- and alcohol-related correlates of self-medication for sleep, and assessed its concurrent and prospective associations with insomnia symptoms, alcohol drinking, and negative drinking consequences. Participants: Undergraduate students (N = 171; mean age = 19 years [SD = 1.35], 32% male, 74% White) enrolled in a four-year university in the northeastern United States. Methods: Data were drawn from a short-term two-wave longitudinal study. Participants completed two online surveys, separated by an average interval of 68 days (SD = 10.22). Results: At Time 1, 25% of students reported using at least one substance (alcohol, marijuana, or over-the-counter medications) for sleep aid in the past two weeks. Male and older students were more likely to report using substances for sleep. Sleep aid use at Time 1 was concurrently associated with greater levels of alcohol frequency, negative drinking consequences, and insomnia symptoms. Further, sleep aid use at Time 1 was associated with an increase in negative drinking consequences from Time 1 to Time 2, but not with changes in alcohol frequency or insomnia symptoms. Conclusions: These findings indicate that substances are widely used among college students for sleep aid. Sleep aid use is associated with greater concurrent drinking and insomnia symptoms, and increases in negative drinking consequences over a short time period.

The effects of depression, anxiety and sleep disturbances on cognitive impairment in patients with chronic obstructive pulmonary disease.

The purpose of this study was to investigate the effects of depression, anxiety and sleep disturbances on cognitive functions in chronic obstructive pulmonary disease (COPD) patients. In this prospective case-control study, demographic data, smoking history, depression, anxiety, sleep quality and cognitive status of 48 COPD patients and 36 healthy volunteers aged 40-90years were recorded. The Beck depression inventory (BDI), the Beck anxiety inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI) were used to assess depression, anxiety and sleep quality, respectively in COPD patients. Cognitive performance was studied by the mini-mental state examination. The mean age of patients with COPD was 65.3±9.4years, and disease duration was 9.6±7.8years. Male sex ratio, smoking, BDI score, BAI score, total PSQI score, sleep latency, sleep duration, average use of sleep aids and sleep disturbances in patients with COPD were significantly higher than the control group (p<0.05). When cognitive impairment was compared by age, FVC, FEV, FEV/FVC, PEF values and smoking, no statistically significant relationship was found (p>0.05). A statistically significant relationship was established between cognitive impairment and severity of disease, presence of anxiety, presence of depression and sleep quality. In our study, we found that sleep disorders, depression and anxiety comorbid with COPD increased cognitive impairment as well as the severity of disease. We believe that this finding is important in terms of reducing the risk of cognitive impairment, preventing misdiagnosis and treatment of the aforementioned comorbid diseases.

Sickness absenteeism is associated with sleep problems independent of sleep disorders: results of the 2016 Sleep Health Foundation national survey

IntroductionSleep disorders are associated with sickness absenteeism (SA), at significant economic cost. Correlates of absenteeism are less well described in nonclinical samples. Participants and methodsWe determined the relationship between markers of inadequate sleep and SA in a sample of 551 working adults aged ≥18 years across Australia. We considered diagnosed obstructive sleep apnea (OSA) and insomnia symptoms, daytime symptoms, and sleepiness with respect to sickness absenteeism (missing ≥1 day of work in the past 28 days because of problems with physical or mental health). ResultsSickness absenteeism was reported by 27.0% of participants and was more frequent in younger participants, university graduates, and those experiencing financial stress. Sickness absenteeism was independently associated with insomnia (odds ratio [OR]=2.5, confidence interval [CI]=1.5-4.0], OSA (OR=9.8, CI=4.7-20.7), sleep aid use (OR=3.0, CI=1.9-4.7), and daytime symptoms (OR=3.0, CI=2.0-4.6) and inversely associated with perception of getting adequate sleep (OR=0.6, CI=0.4-0.9). Associations persisted in the population free of insomnia and/or OSA. ConclusionsIn adults without clinical sleep disorders, sleep behaviors are contributing to sickness absenteeism. An increased focus at an organizational level on improvement of sleep hygiene is important to reduce lost work performance.

Does exercise promote sleep in the elderly?

EVIDENCE-BASED ANSWER Aerobic exercise and resistance exercise programs lead to small to moderate improvements in sleep quality and decreases in use of pharmacologic sleep aids in middle-aged to elderly patients (SOR: A, meta-analysis of RCTs). Tai chi moderately improves sleep quality, latency, duration, and habitual efficiency, and reduces sleep disturbance and daytime dysfunction in the elderly (SOR: A, meta-analysis of RCTs). Baduanjin, an exercise similar to tai chi, also improves sleep quality in elderly patients (SOR: C, small RCT).

Managing sleep problems using non-prescription medications and the role of community pharmacists: older adults' perspectives.

ObjectivesTo examine older adults’ perspectives regarding managing sleep problems through selection and use of non‐prescription sleep aids, and the role of pharmacists.MethodsTelephone interviews were conducted from May to June 2015 with 116 individuals aged ≥60 years in Pittsburgh, Pennsylvania. Participants reported in a previous survey to have used at least one non‐prescription sleep aid in the past 30 days and were willing to participate in a follow‐up interview. Interview guides were designed to elicit perspectives of sleep problems, selection and use of non‐prescription sleep aids, and consultation with healthcare professionals. Interview transcripts underwent content analysis.Key findingsFour themes emerged as follows: experiences with sleep problems, selection of non‐prescription sleep aids, non‐prescription sleep aid use and interactions with healthcare professionals. Over half of participants reported using a non‐prescription sleep aid for >1 year, were satisfied with its use and perceived it improved sleep quality. Participants commonly used an antihistamine‐only sleep aid; 36% of participants self‐recommended their sleep aid; and 16% of participants consulted healthcare professionals. Few participants read medication dosage labels (22%), side effects or warnings (19%), and many reported they disregarded directions. Participants did not typically consult pharmacists about sleep problems (65%) but perceived that they could assist with medication concerns.ConclusionsAlthough most participants had favourable perceptions of non‐prescription sleep aids, older adults may be inappropriately using non‐prescription sleep aids to self‐manage sleep problems by frequently disregarding medication labels and directions for safe use. Also, few older adults are discussing their sleep aid selection and use with pharmacists.

Payer Perspective of the American Academy of Sleep Medicine Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia

Payer Perspective of the American Academy of Sleep Medicine Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia

LO032: Use of pharmacological sleep aids among emergency medicine staff physicians in a Canadian tertiary-care setting: a web based survey

Introduction: Emergency medicine by its nature requires shift-work that often follows an erratic and unpredictable pattern. Faced with this ongoing challenge we hypothesized that many ED physicians may have taken steps to minimize their personal sleep deprivation through the use of a pharmacological sleep aid (PSA). The extent and nature of PSA use in this population is not well studied. We sought to describe the use of PSAs amongst practicing ED physicians in a Canadian tertiary-care setting. We also hoped to determine the specific substances being used, their frequency and predictive factors contributing to their use. Methods: A cross-sectional descriptive web-based survey was sent via e-mail to all practicing staff emergency physicians within the Calgary zone of Alberta Health Services. Participation was entirely voluntary and all responses were anonymous. Descriptive statistics were used to assess frequencies and summary measures. Logistic regression was used to explore associations between key variables. Results: Of the 198 eligible ED physicians, 144 (73%) completed the survey. 132 (92%) felt that shift-work negatively affected their ability to sleep and 121(84%) had experienced insomnia at some point in their medical career. 96(67%) ED physicians had used a PSA at some time in their career and 82(57%) were currently using a PSA with any frequency. The most frequent sleep aids currently being used were non-benzodiazepine hypnotics (65%), alcohol (31%) and melatonin (27%). 66(46%) respondents required a prescription for their PSA and 37(56%) of those had obtained a prescription from an ED physician colleague. Physician self-reporting of experience with insomnia was strongly associated with prior use of any PSA (OR 4.0; 95% CI 1.6-10.0) and prior use of non-benzodiazepine hypnotics (OR 14.4; 95% CI 3.2-64.2) There was no statistically significant association between current use of a PSA and physician age, physician gender, number of night shifts worked per month or co-habitation with children. None of the physicians who responded felt that their use of a PSA adversely affected their ability to provide quality patient care. Conclusion: Pharmacological sleep aid use among Canadian ED physicians may be more common than previously assumed. This could have implications for physician wellbeing and performance.

Prevalence and Predictors of Prescription Sleep Aid Use among Individuals with DSM-5 Insomnia: The Role of Hyperarousal

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. 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. 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. 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.

Pharmacotherapy for Insomnia in Primary Care.

Pharmacotherapy for insomnia in primary care settings can be challenging. Frequently, there are multiple coexisting medical and psychiatric conditions, drug interactions, concern regarding use of habit-forming sleep aids, and paucity of time in office visits to discuss management of sleep difficulties. This article reports the results of a literature search related to pharmacotherapy for insomnia and presents 4 clinical vignettes with corresponding treatment options.

Sleep Health and Appropriate Use of OTC Sleep Aids in Older Adults-Recommendations of a Gerontological Society of America Workgroup.

Getting a good night's sleep can be challenging for older adults with chronic medical conditions, which often interfere with sleep. As a result, many older adults turn to over-the-counter (OTC) sleep aids, that is, products with diphenhydramine or doxylamine. However, these products are indicated only for occasional difficulty with sleep, not for chronic use; and their safety and efficacy has not been well established in general and in older adults specifically. To engage national stakeholders in a discussion of OTC sleep aids in older adults, the Gerontological Society of America (GSA) convened a multidisciplinary workgroup. The Workgroup examined differences between younger and older adults in sleep health and use of OTC sleep aids using data from the National Health and Wellness Survey; assessed the pharmacologic properties and medication effects of OTC sleep aids; and worked with stakeholders to promote strategies for safe and effective use. Older adults are more likely to take diphenhydramine or doxylamine products 15 or more days in a month, an indicator of inappropriate use. The Workgroup recommends research to investigate the ways older people use OTC sleep aids. The goal should be reduction in inappropriate use and associated risks, such as daytime sedation, compromised cognitive function, and falls. In addition, the Workgroup recommends a greater role for community pharmacists in counseling older adults on appropriate use of OTC sleep aids.

PND51 - Sex Differences In over-the-counter sleep aid use in older adults

PND51 - Sex Differences In over-the-counter sleep aid use in older adults

Pharmacological treatment(?) of Sleep Problems in a Swedish Pediatric Setting

AimThe purpose of this study is to investigate the clinical use of sleep aids, specifically melatonin for sleep disorders in children and adolescents in treated at various facilities in Uppsala County, SwedenMethodA cross sectional study was conducted using a short 9 question web‐based survey. The survey contained questions about sleep medications in general and some specific questions about melatonin/Circadin®. The questionnaire was then sent to doctors in various clinics in Uppsala County, Sweden.ResultsPreliminary results shows that the majority of the doctors prescribe some sort of sleep aid, where Circadin® was the most commonly prescribed sleep aid; with melatonin as a close second (Melatonin not an OTC‐drug in Sweden). Sleep aid was prescribed to children of all ages; and most often in conjunction to various neuropsychiatric disorders. The average dose was 2‐3 mg melatonin /Circadin® per day, with some prescribing up to 6 or 9 mg per day.ConclusionThese preliminary results indicate that the doctors prescribe Circadin® to a larger degree. This despite that Circadin®'s current indication is for people &gt;55 years old. Moreover, high doses of melatonin are prescribed, most probably leading to next‐day drowsiness and sub‐optimal functioning of the children. Doctors need to be informed about proper choice of drug and dose for the pediatric patient

Disentangling racial/ethnic and socioeconomic differences in self-reported sleep measures: the Boston Area Community Health Survey

BackgroundRacial/ethnic differences in sleep are widely reported. However, the extent to which socioeconomic factors account for crude variation in sleep parameters by racial/ethnic groups is not clearly understood. MethodsWe studied 4144 individuals in the Boston Area Community Health Survey (2006-2010), a racially/ethnically balanced population-based cohort of black, Hispanic, and white men and women. Self-reported sleep measures were sleep duration, sleep latency, restless sleep, risk for sleep apnea, and sleep medication use. We assessed changes in the age- and sex-adjusted association between race/ethnicity and sleep measures after additional adjustment for individual socioeconomic factors (income, education, and employment) and lifestyle and behavioral factors. ResultsSelf-identified non-Hispanic black race/ethnicity was significantly associated with higher odds of short sleep duration (fully adjusted odds ratio [OR], 1.93; 95% confidence interval [CI], 1.41-2.64), longer sleep latency (fully adjusted, 20.9% longer; 95% CI, 4.1-41.9), and lower odds of pharmaceutical sleep aid use (fully adjusted OR: 0.47, 95% CI: 0.34, 0.65) than white race/ethnicity. Education level accounted for the most substantial reduction in estimates of the age- and sex-adjusted association between black race/ethnicity and short sleep duration and sleep latency. Having less than a 4-year college education was associated with approximately 55% lower sleep latency than having postgraduate education. No significant associations were observed comparing Hispanic to white participants. ConclusionsSignificant variation was observed between black and white race/ethnicity in short sleep duration, sleep latency, and sleep aid use. Although considerable variation in sleep by race/ethnicity was explained by education level, additional variation in self-reported sleep by race/ethnicity may be due to other unmeasured socioeconomic, lifestyle, or behavioral factors.