Who misuses sedatives for sleep? Evidence from a nationally representative US sample

Sedative misuse specifically for sleep is a public health concern, yet little is known about its prevalence or social patterning in the general population. This study estimates the proportion of US adults who misuse sedatives specifically for sleep and identifies the sociodemographic and health correlates of this behavior. We analyzed data on adults aged 18+ from the 2021-2023 National Survey on Drug Use and Health (NSDUH, n = 138,787) and fit survey-weighted multinomial logistic regression models predicting sedative misuse based on sociodemographic and health covariates. We found that 0.27% of the adult population reported misusing sedatives specifically for sleep, corresponding to roughly 681,000 Americans. Sedative misuse for sleep was significantly more common among those with higher income, more education, and non-Hispanic White adults, a pattern consistent with healthcare access advantages. At the same time, sedative misuse for sleep was also elevated among people attracted to the same sex, those with a history of incarceration, and those with chronic health conditions and poor mental health, suggesting concentrated health burdens are also associated with misuse. These findings reveal that sedative misuse for sleep is consistent with two distinct social processes operating simultaneously: access advantages among socially privileged groups and greater sleep-related health needs among vulnerable populations. Clinical and policy attention to sedative misuse should therefore extend beyond traditionally targeted vulnerable populations to also include those with greater healthcare access.