Pediatric Hypnotic Prescribing in Japan: A Decade of Change Before and After COVID-19
Lead
Sleep medication use among children and adolescents in Japan more than doubled over the past decade, with a significant acceleration following the COVID-19 pandemic, according to a large observational study published in Sleep Medicine. The research, led by Nao Matsuyama and colleagues at Nagoya University Graduate School of Medicine and Kobe University Hospital, analyzed insurance claims data from over 2.4 million young people and found that the proportion prescribed hypnotics rose from 0.4 percent in 2014 to 1.0 percent in 2023, a 2.5-fold increase.
What they found
The team used the JMDC Claims Database, a large Japanese administrative health dataset, to examine prescribing patterns for children and adolescents aged 2 to 18 years between January 2014 and December 2023. In 2014, roughly 2,800 of 673,141 eligible children had been prescribed a hypnotic. By 2023, that number had climbed to nearly 24,000 out of 2.4 million. The absolute numbers reflect both a rising rate and a growing database population, but the trend in proportions is unambiguous.
The increase was not uniform across age groups. Adolescents and females experienced the largest rises, a pattern the authors describe as consistent with known sex differences in insomnia prevalence that emerge after puberty. When the researchers performed an interrupted time-series analysis around April 2020, the date Japan declared its first COVID-19 state of emergency, they found a statistically significant change in the slope of prescribing rates. After April 2020, prescriptions rose by an additional 3.64 per 100,000 per month (95 percent CI 2.69 to 4.58, P less than 0.001) compared with the pre-pandemic trend. Notably, there was no immediate jump in prescribing at the emergency declaration; the increase was gradual, manifesting as an accelerated upward trend rather than a sudden spike.
Equally important were the changes in which medications were being prescribed. Benzodiazepines and benzodiazepine receptor agonists, the traditional first-line pharmacologic options for insomnia, declined over the study period. Meanwhile, melatonin receptor agonists (such as ramelteon) and orexin receptor antagonists increased substantially. This pharmacological shift mirrors broader changes in adult sleep medicine, where concerns about dependence, tolerance, and cognitive side effects have driven prescribers away from benzodiazepines and toward newer agents with more targeted mechanisms of action.
The authors conducted a sensitivity analysis that excluded melatonin receptor agonists from the counts, given that melatonin is often used as a mild, over-the-counter-like option. In this analysis, the post-emergency acceleration in prescribing was attenuated overall, but it persisted among adolescents, suggesting that the pandemic effect was not simply an artifact of increased melatonin prescribing but reflected a genuine rise in prescription hypnotic use, particularly among older children.
Why it matters
Pediatric insomnia is common, with prevalence estimates ranging from 10 to 30 percent depending on age and diagnostic criteria. Despite this, there is relatively little evidence on the safety and efficacy of pharmacologic sleep aids in children, and clinical guidelines generally recommend behavioral interventions as first-line treatment. This study provides the most comprehensive long-term picture of prescribing practices in a large, non-Western healthcare system and documents how two forces, evolving clinical preferences away from benzodiazepines and the psychosocial disruption of the pandemic, combined to reshape prescribing.
The findings carry several implications. First, the accelerating trend during COVID-19 suggests that pandemic-related stressors, disrupted routines, increased screen time, and reduced access to behavioral sleep interventions may have led clinicians to reach more readily for medication. Second, the shift toward melatonin agonists and orexin antagonists may reflect appropriate deprescribing of riskier agents, but it also raises questions about the long-term effects of these newer drugs in pediatric populations, for which long-term safety data remain limited. Third, the persistent adolescent effect, even after removing melatonin from the analysis, identifies a subgroup that warrants particular clinical attention and further research.
Limits
As an observational study using administrative claims data, the analysis cannot determine why prescriptions were written or whether they were clinically appropriate. The JMDC database is drawn primarily from employees of large companies and their dependents, which may limit generalizability to children from lower-income households or those covered by other insurance schemes. The study also cannot capture hypnotic use that was purchased over the counter without a prescription, or behavioral sleep interventions that did not result in a prescription claim. Additionally, the authors disclose potential conflicts of interest: several report consulting or speaking fees from pharmaceutical companies including Eisai, Lundbeck, MSD, Otsuka, Takeda, Meiji Seika, Sumitomo, Taisho, Viatris, Daiichi Sankyo, Mochida, Janssen, Mitsubishi Tanabe, Kyowa, and Towa. One author (M. Ikeda) serves on the board of Genonyxs Inc.
Bottom line
Prescribing of sleep medications to children and adolescents in Japan more than doubled from 2014 to 2023, with an accelerated rise following the COVID-19 pandemic and a clear shift away from benzodiazepines toward newer drug classes. The findings underscore the need for better pediatric sleep services, expanded access to behavioral interventions, and rigorous long-term safety monitoring of hypnotics in young people.
Source
Matsuyama N, Iwamoto K, Miyata S, Imai T, Ikeda M. Ten-year trends in pediatric hypnotic prescribing before and during the COVID-19 pandemic in Japan. Sleep Med. 2026;146:109108. DOI: 10.1016/j.sleep.2026.109108. PMID: 42392020.