Insomnia. “It’s a lifestyle thing; everybody’s got it,” says Gregg Jacobs, an insomnia specialist at the Sleep Disorders Center at the University of Massachusetts Medical School. More than half of American adults report that they suffer from insomnia symptoms – trouble falling asleep or waking up during the night – a few times a week, according to the National Sleep Foundation.
About 8 million adults turn to prescription sleeping pills for help every month, according to a study published last year by the Centers for Disease Control and Prevention. And yet, Jacobs warns, these medications all have flaws.
Popular prescription medications for insomnia include the so-called Z-drugs: Ambien (zolpidem), Lunesta (eszopiclone) and Sonata (zaleplon). These drugs have shorter durations of action than older drugs such as the benzodiazepine Dalmane (flurazepam). That means they may help you fall asleep, but their effects don’t last long. They also are less likely to lead to morning grogginess.
And yet, recent data show that even the Z-drugs can cause problems. Last year, the FDA recommended that prescribed doses of Ambien be lowered, particularly for women. This came after reports of lingering effects in the morning, including drowsiness and impaired driving.
There are concerns with the Z-drugs in elderly people as well, with persisting effects causing daytime confusion, memory problems and falls, Jacobs says. In fact, the American Geriatric Society, which publishes a list of medications that the elderly should avoid because their side effects outweigh their benefits, recently discouraged the use of Z-drugs for any period longer than 90 days. Benzodiazepines when taken for insomnia are on the list as well.
The Z-drugs have similar effects on the brain as Dalmane and other benzodiazepines such as Klonopin and Halcion. These drugs act on GABA receptors, inhibiting neuronal function and thus tending to dampen many brain functions, including a wakeful state. It was hoped that the Z-drugs, thought to interact with a smaller subset of GABA receptors than the benzodiazepines, would produce fewer side effects than those drugs. However, many studies have found little difference between them. Other drugs are prescribed for sleep, such as certain antidepressants (Desyrel and Sinequan) that tweak the balance of brain chemicals involved in mood and alertness and the melatonin-mimicking drug Rozerem (ramelteon), which delivers sleeptime signals to the brain.
“It’s important to pick the right medicine to match your problem,” says Thomas Roth, a sleep medicine researcher at the Henry Ford Hospital in Detroit. It’s equally important to know that there’s a nondrug alternative.
Indeed, cognitive behavioral therapy, which includes using relaxation techniques, controlling stimulation before bedtime and reframing how people think about their sleep needs, may work better than any pill. Ten years ago, Jacobs published a study that found cognitive behavioral therapy superior to Ambien, producing bigger effects in falling-asleep time and in overall sleep-vs.-wakeful time in bed.
Behavioral treatment and Ambien in combination did not produce any greater effect than behavioral treatment alone.
If you do go the medicine route, understand that drugs’ sleep-inducing effects are limited and that side effects may make them not worth your while.
A review of clinical trials found that, on average, people taking Z-drugs fall asleep 22 minutes sooner than those taking a placebo. But these drugs don’t last long, so they don’t help keep you asleep in the pre-alarm clock hours.
Short-term side effects can include:
If you have taken the drug long term (beyond a month or three), side effects may include:
“Insomnia is a chronic disorder, and chronic problems require chronic treatment – under supervision,” Roth says. “It’s worth seeing a doctor who knows the meds and who also knows about behavioral treatments.”
So if your sleep troubles are frequent and persistent, see a doctor – preferably a sleep specialist.