Possibly less addictive, definitely more expensive, the new sleep aids offer hope to those of us who suffer with insomnia – but only after nonpharmacologic approaches have failed.
Insomnia is a common affliction: About a third of Americans report trouble sleeping. More and more, people are resorting to prescription sleep aids to combat insomnia. Prescriptions for sleep aids nearly doubled between 2001 and 2005, from 29 million to 49 million.
Before even considering medication for a sleep problem, consider taking some basic steps to make your home and daily routine more sleep friendly. This includes making sure your bedroom environment is comfortable, dark, and quiet at night, sticking to a regular sleep-wake schedule, exercising regularly, and avoiding alcohol, food, and stimulating mental activities in the evening close to bedtime. For some people, a form of counseling called cognitive-behavioral therapy (CBT) may be as effective for treating insomnia as sleeping pills.
There are many medical causes of disturbed sleep, among them chronic heartburn, depression, congestive heart failure, arthritis pain, sleep apnea that interferes with night-time breathing, and urinary tract infections, uncontrolled diabetes, or prostate trouble that rouses one from bed to bathroom. In these cases, sleeping pills are not the medications to use. But used appropriately, prescription sleep aids help many people get the sleep they want.
When an otherwise healthy person suffers from chronic insomnia (difficulty sleeping three or more times per week for an extended period), one step people can easily take is occasional use of over-the-counter sleeping pills that contain an antihistamine, which causes drowsiness as a side effect.
If the problem persists, doctors may prescribe a "hypnotic” medication to induce sleep. The hypnotics produce sleep by suppressing brain activity. Common older-generation hypnotics are benzodiazepines, including diazepam (Valium), triazolam (Halcion), alprazolam (Xanax), and temazepam (Restoril). These drugs act by enhancing the activity of a brain chemical called GABA, which reduces arousal, thereby helping you to fall asleep.
Older hypnotics are widely available in affordable generic versions. On the downside, their effects may persist into the following day, leaving you with a groggy sleeping-pill "hangover” or, more rarely, amnesia or confusion. Among older people, hypnotics raise the risk of injurious falls. Also, over time your brain can habituate to the effects of hypnotics, causing you to need higher doses for the same effect. In addition, it is possible to become addicted to them. For these reasons, hypnotics are recommended only for short-term or occasional use.
In the past decade, pharmaceutical companies have developed new hypnotics. They have a similar mechanism of action in the central nervous system but are in a different chemical class than the older drugs. They are reputed to reduce the frequency of side effects such as next-day grogginess, unsteadiness, and memory impairment. The new sleeping pills are also reported to have less potential for addiction than older hypnotics.
The new-generation hypnotics, which include zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta), are heavily advertised and widely prescribed. Ambien remains the market leader, at least recently. Another new hypnotic, called ramelteon (Rozerem), works in a unique way by simulating the effect of melatonin, a natural brain chemical that regulates the daily sleep-wake cycle.
Some research suggests that people can use these new sleeping medications long term with less risk of adverse effects than the older generations of hypnotics. However, there are reports and warnings of addiction, withdrawal symptoms when people stop them suddenly after prolonged use (for example, for a surgical procedure or hospitalization for an acute illness), and mental impairment. They are also more expensive.
Which sleeping pill is right for you? It depends on many factors and should be a matter of discussion and evaluation with your physician.
- Whenever you take sleeping pills, don’t mix them with alcohol.
- Take care if you rise during the night; you may feel unsteady on your feet and could fall and hurt yourself.
- Make sure you and your family tell your doctor if you develop any unusual behaviors or symptoms while taking sleeping pills.
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