(This article appeared previously on MedShadow.org.)
A group of medicines that became wildly popular over the past 20 years ended up posing serious dangers to some of the people who took them and to public health. But they also helped millions of people get a little bit more sleep. Yes, we are talking about insomnia drugs — sleeping pills.
The declining use of such drugs is not hard to understand. Reports have focused attention for years on the risks associated with these medicines, their misuse and abuse. Research has also pointed to their general lack of effectiveness at resolving the underlying causes of chronic insomnia.
Why You Should Avoid These Meds If Possible
But here’s the bottom line for people who occasionally have trouble sleeping (most of us) or the unlucky 5 to 10 percent who have chronic insomnia: Don’t take these medicines at all if you can avoid it.
Two in 100 people who took Belsomra experienced the frightening side effect of temporary muscle paralysis and/or an inability to speak.
And if you do need to take one, do so for the shortest time possible. Not more than a week or so. A few days would be better.
Why? Here are seven facts from Consumer Reports Best Buy Drugs. Additional information was provided by Dr. Steven Woloshin and Dr. Lisa Schwartz, both of the Geisel School of Medicine at Dartmouth College; Thomas J. Moore of the Institute for Safe Medication Practices and the Food and Drug Administration (FDA):
- Two-thirds of people taking zolpidem (Ambien, the most widely-known and prescribed sleeping pill) use it for weeks, months or even years — a pattern of use at significant variance with the FDA and manufacturer’s recommendations of seven to 10 days use max. And, in one analysis, one in five people who took zolpidem combined it with an opioid. That increased their risk of potentially fatal depression of the central nervous system — which means they stop breathing — not to mention other ill effects.
- Two to 6 percent of people taking lower doses of zolpidem experience next-day drowsiness, even when they had taken the drug six to seven or more hours prior to waking up; 7 to 15 percent of people taking higher doses of zolpidem experience next-day drowsiness. (Because of this side effect and its link to traffic accidents and other untoward events, the FDA in 2013 lowered the recommended initial dose.)
- Seven percent of people taking either the 10mg or 20mg dose of suvorexant (Belsomra; the newest drug in this class and one of the most heavily advertised drugs over the last year) experienced next-day drowsiness, compared to 3 percent who took a placebo, in clinical trials involving 1,784 patients.
- Sleepwalking or doing other activities when you are asleep (like eating, talking, having sex or driving a car) have been associated with insomnia medicines, including Belsomra. So have memory lapses and hallucinations. Generally, fewer than one in 10 people experience these problems.
- Two in 100 people who took Belsomra experienced the frightening side effect of temporary muscle paralysis and/or an inability to speak. Essentially, they were semi-awake but could not move or speak. This rare side effect is believed to be one reason doctors have been reluctant to prescribe the drug.
- All the insomnia medicines, including Belsomra, carry a risk of dependency. It is not so much physical dependency, as happens with opioids or benzodiazepines like Xanax. It’s more of a psychological dependency, abetted by rebound insomnia, experts say. That’s when you stop taking the medicine and, for a while, have even more trouble falling or staying asleep.
- By the end of last year, the FDA had received 2,378 reports of adverse events/problems associated with Belsomra. That is a relatively high rate of reported events given that less than 500,000 prescriptions have been written for the drug. The most frequent problem cited was that the drug was ineffective (38 percent of reports). The next most frequent was sleep disturbance (27 percent), which included abnormal dreams, hallucinations and sleep paralysis (59 reported episodes).
So doctors and patients appear to be getting wise to the downside of these medicines, and they have resisted Belsomra. This resistance may also be due to its cost: $70 to $80 for seven pills compared to $10 to $20 for seven to 10 zolpidem pills.
Ways to Sleep Easier
If you are among the sleepless, here’s wise advice from Consumer Reports:
- Having occasional trouble sleeping is a universal human experience. Don’t take a pill if you’ve had trouble sleeping for just a couple of nights, especially if the sleep disturbance is due to job or relationship stress or a temporary life upset. This almost always resolves in time.
- Before taking a pill, try improving your sleep habits. Studies show this works. Among the techniques: Relaxation training, setting and sticking to consistent bedtimes and wake-up times, regular exercise, quitting smoking, cutting back on caffeine and alcohol in the afternoon and evening, keeping your bedroom quiet and dark and not watching TV or using a computer in bed (including a smartphone). Read a book instead.
- If you still experience problems and/or have been diagnosed with chronic insomnia (three or more nights a week of poor sleep for eight weeks or more), try cognitive-behavioral therapy (CBT). This involves working with a therapist, possibly at a sleep clinic, to learn a new set of behaviors around sleep. Numerous studies show CBT is as effective as sleeping pills in helping people with chronic insomnia.
- Don’t mix any kind of sleeping pill with alcohol. This advice applies to people of all ages, but is especially important for people over age 65, who are prone to falls and the cumulative sedative effects of multiple medicines.
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