adverse effects may also occur at the low doses used, such as dyslipidemia and neutropenia. such concerns of risks at low doses are supported by danish observational studies that showed an association of use of low-dose quetiapine (excluding prescriptions filled for tablet strengths >50 mg) with an increased risk of major cardiovascular events as compared to use of z-drugs, with most of the risk being driven by cardiovascular death. laboratory data from an unpublished analysis of the same cohort also support the lack of dose-dependency of metabolic side effects, as new use of low-dose quetiapine was associated with a risk of increased fasting triglycerides at 1-year follow-up. concerns regarding side effects are greater in the elderly. other sedatives gabapentinoids like gabapentin and pregabalin have sleep-promoting effects but are not commonly used for treatment of insomnia. gabapentin is not effective in helping alcohol related insomnia. barbiturates, while once used, are no longer recommended for insomnia due to the risk of addiction and other side effects. comparative effectiveness a major systematic review and network meta-analysis of medications for the treatment of insomnia was published in 2022. it found a wide range of effect sizes (standardized mean difference (smd)) in terms of efficacy for insomnia. the assessed medications included benzodiazepines (smds 0.58 to 0.83), z-drugs (smds 0.03 to 0.63), sedative antidepressants and antihistamines (smds 0.30 to 0.55), quetiapine (smd 0.07), orexin receptor antagonists (smds 0.23 to 0.44), and melatonin receptor agonists (smds 0.00 to 0.13). the certainty of evidence varied and ranged from high to very low depending on the medication. the meta-analysis concluded that the orexin antagonist lemborexant and the z-drug eszopiclone had the best profiles overall in terms of efficacy, tolerability, and acceptability. alternative medicine herbal products, such as valerian, kava, chamomile, and lavender, have been used to treat insomnia. however, there is no quality evidence that they are effective and safe. the same is true for cannabis and cannabinoids. it is likewise unclear if acupuncture is useful in the treatment of insomnia. prognosis disability-adjusted life year for insomnia per 100,000 inhabitants in 2004. no data less than 25 25–30.25 30.25–36 36–41.5 41.5–47 47–52.5 52.5–58 58–63.5 63.5–69 69–74.5 74.5–80 more than 80 a survey of 1.1 million residents in the united states found that those that reported sleeping about 7 hours per night had the lowest rates of mortality, whereas those that slept for fewer than 6 hours or more than 8 hours had higher mortality rates. severe insomnia – sleeping less than 3.5 hours in women and 4.5 hours in men – is associated with a 15% increase in mortality, while getting 8.5 or more hours of sleep per night was associated with a 15% higher mortality rate. with this technique, it is difficult to distinguish lack of sleep caused by a disorder which is also a cause of premature death, versus a disorder which causes a lack of sleep, and the lack of sleep causing premature death. most of the increase in mortality from severe insomnia was discounted after controlling for associated disorders. after controlling for sleep duration and insomnia, use of sleeping pills was also found to be associated with an increased mortality rate. the lowest mortality was seen in individuals who slept between six and a half and seven and a half hours per night. even sleeping only 4.5 hours per night is associated with very little increase in mortality. thus, mild to moderate insomnia for most people is associated with increased longevity and severe insomnia is associated only with a very small effect on mortality. it is unclear why sleeping longer than 7.5 hours is associated with excess mortality. epidemiology between 10% and 30% of adults have insomnia at any given point in time and up to half of people have insomnia in a given year, making it the most common sleep disorder. about 6% of people have insomnia that is not due to another problem and lasts for more than a month. people over the age of 65 are affected more often than younger people. females are more often affected than males. insomnia is 40% more common in women than in men. there are higher rates of insomnia reported among university students compared to the general population. society and culture the word insomnia is from latin: in + somnus "without sleep" and -ia as a nominalizing suffix. the popular press have published stories about people who supposedly never sleep, such as that of thái ngọc and al herpin. horne writes "everybody sleeps and needs to do so", and generally this appears true. however, he also relates from contemporary accounts the case of paul kern, who was shot in wartime and then "never slept again" until his death in 1943. kern appears to be a completely isolated, unique case.