COVID-19 Pandemic Increases Sleeping Pill Use Among Insomnia Patients in South Korea

Study Finds Pandemic Drove Surge in Sleeping Pill Prescriptions
Women and Elderly Had Highest Volumes,
Young Adults Saw Sharpest Increase

The COVID-19 pandemic has significantly increased the use of sleeping pills among insomnia patients in South Korea. A joint research team from Seoul National University Hospital and Seoul National University College of Medicine analyzed data from more than 8.14 million insomnia patients nationwide and found that, during the pandemic, the number of sleeping pill prescriptions exceeded previous forecasts across all age groups. In particular, women and those aged 70 and older had the highest absolute prescription volumes, while young adults aged 18 to 29 showed the largest increase relative to expectations.

The joint research team, led by Professor Lee Yoojin of the Department of Psychiatry at Seoul National University Hospital and Professor Shin Aeseon of the Department of Preventive Medicine at Seoul National University College of Medicine (co-first authors: Professor Shin Jiyoon of Seoul Metropolitan Boramae Hospital and Researcher Jeon Soyeon of Seoul National University College of Medicine), announced on August 29 the results of their study analyzing trends in sleeping pill prescriptions among 8,136,437 insomnia patients aged 18 or older (60.4% women) in South Korea from 2010 to 2022, using National Health Insurance data.

Insomnia symptoms are common, with three to five out of ten people experiencing them at some point in their lives. Typical sleep disorders include difficulty falling asleep, frequent awakenings, or waking up early in the morning. If prolonged, insomnia can lead not only to mental health issues such as depression and anxiety, but also to the worsening of physical illnesses and a decline in quality of life. While previous studies abroad have reported increased use of sleeping pills during the pandemic, this is the first large-scale analysis in South Korea comparing forecasted and actual prescription volumes based on pre-pandemic trends.

The research team focused on four classes of medications used to treat insomnia: benzodiazepines, non-benzodiazepines, low-dose antidepressants, and low-dose antipsychotics. They built a predictive model using prescription data from before the pandemic (2010-2019), then compared it to actual prescription volumes during the pandemic (2020-2021). They further analyzed prescription volumes and the number of patients by gender, age group, and drug class.

The analysis showed that, from 2010 to 2022, both the volume of sleeping pill prescriptions and the number of patients prescribed these medications steadily increased across all drug classes. Total prescriptions rose from about 10.5 million in 2010 to about 38.5 million in 2020, about 41.2 million in 2021, and about 42.4 million in 2022-an increase of more than fourfold over 12 years. Women consistently received more prescriptions than men, and those aged 70 and older maintained higher levels than other age groups.

Compared to the pre-pandemic predictive model, actual sleeping pill prescriptions during the COVID-19 period exceeded forecasts across all age groups. Notably, in 2021, young adults aged 18 to 29 surpassed predictions by the largest margin across all drug classes, highlighting the particularly pronounced impact of the pandemic on sleeping pill use among younger people.

Meanwhile, from 2010 to 2022, the most prescribed sleeping pill in South Korea was zolpidem, followed by alprazolam and trazodone. Among drug classes, non-benzodiazepines such as zolpidem were prescribed the most, followed by intermediate-acting benzodiazepines, low-dose antidepressants, and long-acting benzodiazepines. The concurrent prescription of intermediate-acting benzodiazepines and non-benzodiazepines such as zolpidem was also common.

There were also notable changes in actual prescription volumes. Prescriptions for low-dose antidepressants used for sleep increased most sharply in the first half of 2020 compared to 2019, rising by 38.6% (about 1.51 million prescriptions) among men and 37.1% (about 2.31 million prescriptions) among women. Low-dose antipsychotics also saw the second-largest increase during the same period, up 28.9% (about 450,000 prescriptions) among men and 25.7% (about 560,000 prescriptions) among women. Both drug classes maintained higher prescription volumes in 2021 compared to 2019.

In contrast, non-benzodiazepine sleeping pills such as zolpidem showed the smallest increase, with a relatively minor difference from the predicted values.

Professor Lee Yoojin stated, "From 2010 to 2022, the volume of sleeping pill prescriptions steadily increased, with particularly high absolute numbers among women and the elderly. During the pandemic, prescriptions for low-dose antidepressants and antipsychotics used as sleeping pills greatly exceeded predictions, and the increase was especially pronounced among young adults aged 18 to 29. Therefore, it is increasingly important to ensure the safe use of these medications and to monitor side effects, particularly in this demographic."

The results of this study were published online in the international journal of the Korean Academy of Medical Sciences, JKMS (Journal of Korean Medical Science).