The truth about sleeping pills

The truth about sleeping pills

What’s safe, what isn’t, and how to get a good night’s sleep

Published: March 2015

Heavily advertised prescription sleep drugs such as Ambien and Lunesta are sold with the promise of a good night’s rest. For the estimated 25 percent of Americans who occasionally struggle with sleep or the 10 percent with chronic insomnia (trouble falling or staying asleep at least three nights per week for a month or more), the drugs may seem like a quick route to relief.

But new evidence suggests that they aren’t as useful as once thought. They can pose significant risks, especially for older adults. And new drugs keep coming; the latest is suvor­exant (Belsomra). Here’s what you need to know about sleep drugs:

Newer sleep drugs aren’t very effective

Recent analysis by Consumer Re­ports Best Buy Drugs found that people who take newer prescription sleeping pills fall asleep only 8 to 20 minutes faster than with a placebo. That category of sedatives includes eszopiclone (Lunesta and generic); ramelteon (Rozerem and generic); zaleplon (Sonata and generic); and zolpidem (Ambien, Ambien CR, Edluar, Zolpimist, and generic).

Ambien and Lunesta, for example, help people fall asleep only about 20 minutes and 19 minutes faster, respectively, than a placebo, on average. In addition, Best Buy Drugs found that the drugs add just 3 to 34 minutes to total sleep time. Their effectiveness is so limited that as of late 2014 they were no longer considered a first-choice treatment for chronic insomnia by the American Aca­demy of Sleep Medicine (AASM).

Safer strategy: Try sleep therapy (see below). Our analysis found that it might be as effective, if not more so, as drugs.

Want to read more details about drugs to treat insomnia? See our Consumer Reports Best Buy Drugs report.

Older drugs are risky

Older prescription sedatives called benzodiazepines are used primarily for anxiety. But several are FDA-approved for insomnia: estazolam (generic), flurazepam (Dalmane and generic), quazepam (Doral), and temazepam (Restoril and generic). Our analysis found them to be generally no more effective than the newer sleeping pills. Studies suggest that they have a higher risk of day-after sleepiness and grogginess, dependency, and rebound insomnia. Despite years of concern, those drugs are prescribed to older adults at a disproportionate rate. And a new study in JAMA Psychiatry found that older adults are more likely to take them for far longer than recommended.

Safer strategy: Consider a benzo­diazepine only if you have a diagnosed anxiety disorder that disrupts sleep, and use it only intermittently.

Newer sleep drugs can have side effects, too

Although they seem to cause fewer side effects than benzodiazepines, drugs such as Ambien and Lunesta can cause dependency, daytime drowsiness, and dizziness, and may worsen sleep problems if you stop taking them after regular use. And in rare cases, people have reported sleep driving, sleep eating, amnesia, and hallucinations. In addition, the older you are, the more intense the sleep-inducing effects and side ­effects may be.

Taking any of those drugs (or a benzodiazepine) can impair your driving ability and increase your risk of falls and hip fractures. And a 2013 government report noted a 220 percent jump in emergency room vis­its for adverse reactions to zolpidem between 2005 and 2010. A study published in JAMA Psychiatry in 2014 found that about 21 percent of psychiatric drug-related ER visits were by people 65 and older taking zolpidem.

Safer strategy: It’s best to take the lowest dose possible for no longer than a few days.

OTCs can pose problems

Older over-the-counter antihistamines such as diphenhydramine (Benadryl Allergy, Nytol, Sominex, Tylenol PM, and generic versions), and doxylamine (Unisom and generic) may be useful for very short-term insomnia. But rebound insomnia is a concern, as is daytime drowsiness, confusion, constipation, dry mouth, and problems urinating. And a 2015 study published in JAMA Internal Medicine reported a higher risk of dementia in people who regularly used those type of drugs, which are known as anticholinergics.

Safer strategy: Use OTCs for no more than one or two nights at a time. If your insomnia lasts longer than a few days, check in with your doctor.

Trazodone: Not for sleep

Trazodone, an older antidepressant, is commonly prescribed off-label for insomnia. But in the one study that tested it against a placebo and Ambien, it was only slightly more effective than the placebo and less effective than Ambien. The drug can cause next-day drowsiness and very low blood pressure, which can lead to fainting.

Safer strategy: Unless your doctor has diagnosed depression, or until other studies show it effective for use in those without depression, skip trazo­done for sleeplessness.

How to stay safe

What’s the bottom line? Hypnotics, or sleep-inducing medication, “can be helpful under certain circumstances,” says Timothy Morgenthaler, M.D., president of the AASM. Brief use may help if you develop short-term insomnia caused by jet lag or a major life change. They may also let you get some rest as you learn lifestyle strategies. But:

  • Take them only if you have time for at least 7 to 8 hours of sleep, so the effect has time to wear off.
  • Never mix a sleep drug with alcohol or sedatives.
  • Don’t rely on them every night (or almost nightly) for months or more. That boosts the likelihood of adverse effects.
  • Take the lowest effective dose.
  • If you’re offered a sleep drug in the hospital, think twice. A 2014 study found that 26 percent of subjects received sleep drugs while hospitalized. And 34 per­-cent of those who hadn’t used a sleep aid before admission left with a prescription for one.  

Better sleep tips

Try one or more of the following approaches before you take a sleep aid. Over time, they may be your ticket to a good night’s rest.

  • Stay on schedule. Go to bed and get up at the same time every day. Can’t sleep? Leave the bedroom and do something restful, such as reading, until you feel sleepy. If you nap, do so before 3 p.m. for no more than 30 minutes.
  • Make changes in your bedroom. Block out noise and outside light. Make sure that your mattress and room temper­ature are comfortable. Remove the TV.
  • Eat and drink wisely. Avoid or minimize alcohol, caffeine, and nicotine; they can affect sleep. Don’t eat heavily within several hours of bedtime.
  • Exercise regularly. It promotes healthy sleep (but not shortly before bedtime).
  • Get natural light. A study at the University of Illinois at Urbana-Champaign found that people exposed to natural light at work slept better and longer.
  • Turn off e-readers and other devices 2 hours before bed. They can emit blue light, which suppresses levels of melatonin, the hormone that regulates sleep. If you can’t unplug, dim the device and hold it at least 14 inches from your eyes.
  • Reduce stress. Meditation, yoga, and tai chi can help. For example, a study published in the Journal of the American Geriatrics Society found that six months of tai chi three times per week helped older adults fall asleep faster and sleep longer.
  • Get a checkup. Some medications and health problems can disrupt sleep, so see your doctor if lifestyle strategies haven’t helped after a month.
  • Try sleep therapy. Research has found that cognitive behavioral therapy for insomnia (CBT-I) is quite effective at helping people with sleep problems fall asleep and stay asleep. “CBT-I rebuilds people’s confidence in their ability to sleep,” says Ryan G. Wetzler, Psy.D., director of Behavioral Sleep Medicine at Sleep Medicine Specialists in Louisville, Ky. CBT-I is often covered by insurance and doesn’t require a significant time commitment. Wetzler says that his patients usually see improvements after only six visits.

 

 

Editor's Note:

This article also appeared in the May 2015 issue of Consumer Reports on Health.  

 

This article originally appeared in Consumer Reports On Health May 2015 newsletter. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).



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