Sleeping pills are more popular than ever–especially for women over fifty. But are they a safe solution?
FOF Founder, Geri Brin, has been taking prescription sleeping pills for 5 years. “I don’t know what would happen if I tried to sleep without them,” she explains. “I’m afraid to try.”
According to The National Sleep Foundation, a full 61-percent of post-menopausal women suffer from insomnia, and prescriptions for the new class of sleep aids, which include Ambien, Lunesta and Sonata, have doubled in the last five years. These meds are clearly popular, but are they safe, and–more important–are they the solution?
We spoke to Dr. Jessica Vensel-Rundo, a doctor at the Cleveland Clinic’s renowned Sleep Disorders Center, to get the straight dope about doping up to fall asleep.
- FOF: Why is insomnia so common in women over fifty?
- Dr. Vensel-Rundo: Several insomnia triggers are common in this population: depression and anxiety, often due to a life change such as a death in the family, loss of a job or a divorce. Pain is also a big issue, whether from arthritis, fibromyalgia or something else. And hormone fluctuations and hot flashes due to being post-menopausal. Those are the top ones. In about 15 percent of cases, the person has primary insomnia, which means there’s no underlying medical problem causing the insomnia.
- When is medication a good treatment idea?
- Dr. Vensel-Rundo: As a short-term solution, medication can be great. That’s really how these medications were initially tested–for six weeks of use. They were intended to help you through a rough patch such as a death in the family or recuperation from an operation. The problem with sleep medications is that they may be a quick fix, but they can lose effectiveness over time. You build up a tolerance or develop side effects, and when you take the medication away, the insomnia is still there.
- So what is the long-term solution?
- Dr. Vensel-Rundo: Cognitive behavioral therapy is the main non-drug treatment for insomnia. That includes relaxation techniques, biofeedback and sessions with a sleep psychologist. Some patients are just not interested in that type of commitment. They may say, “Look, I’ve tried some of these things before and they’re not going to work for me.’ Those are the patients who typically opt for medication alone.
- Would you prefer that patients opt for other treatments beforethey go to a medication?
- Dr. Vensel-Rundo: Yes. In general we–sleep medicine specialists–feel that the cognitive and behavioral treatment is the best treatment out there, because it actually retrains you to fall asleep on your own. Studies have show that the effectiveness is probably about the same as a pill, initially, but in the longterm, it’s really the cognitive treatment that works.
- Are there times when people go on the medication alone for 6 weeks, get back on track and are just fine?
- There are, but often patients will hit the six-week mark and be afraid to stop taking the medication. For those people, I try to ease them off of it.
- Several women at the FOF offices–including our founder–have remarked that their doctors were very quick to prescribe sleep medications when they complained of trouble sleeping. Is this typical?
- Dr. Vensel-Rundo: I think a lot of doctors in primary care are more likely to write a prescription because they are dealing with multiple medical problems. If a patient comes in complaining of a few things and mentions in passing, “oh, I’m also having some trouble sleeping…” the doctor may decide to prescribe a medication to address the issue immediately, hoping it will be a short-term problem. At the sleep center, our whole focus is sleep, so we do a very thorough history and really try to get a better feel for what is going on before we prescribe any treatment.
- What are the biggest dangers of these medications?
- Dr. Vensel-Rundo: There has been a lot of media coverage on dangers such as driving, eating or making phone calls in your sleep. The truth is, those are very rare. I’ve only had one or two patients complain to me about those types of symptoms. Most of the side effects are no more than a woozy feeling the next morning if you take it too late the night before.
- Are these medications addictive?
- Dr. Vensel-Rundo: The ones that we’re discussing–the non-benzodiazepine hypnotics such as Lunesta, Ambien and Sonata–are not addictive. You can build up a tolerance to them, and they can lose their effectiveness over time. If you come off of them abruptly, you can have “rebound insomnia” so I typically recommend that my patients come off of them gradually. The benzodiazepines which are sleep medications such as Ativan, have some addictive properties. We rarely prescribe those.
- Is any one medication better than the others? How do you choose?
- Dr. Vensel-Rundo: It really depends on what the patient is complaining of. If it’s a sleep initiation problem–a difficulty falling asleep–then Ambien would probably work well. But if it’s a sleep maintenance issue–meaning you’re getting up a lot in the night–then there’s Lunesta or Ambien CR which are designed to help you stay asleep. Honestly, it’s often an insurance issue–which medication is covered by insurance and which is least expensive. Ambien is a cheaper alternative because it’s available in a generic form called Zolpidem. Most of us prescribe it more for that reason.
- What about dangers of people using them the wrong way…or abusing them.
- Dr. Vensel-Rundo: I’ve had a couple of patients who were taking double the maximum dose of Ambien plus an antidepressant, an anti-anxiety and a pain medication, and they’re still not sleeping. Taking a high dose of Ambien or Sonata alone would probably not be a significant problem, but if you add them to pain medications and anxiety medications, that’s an issue because the combination can cause central nervous system depression and respiratory depression.
- What about melatonin and other over-the-counter medications?
- Dr. Vensel-Rundo: Melatonin works well for people who have a delayed sleep phase. That means they don’t feel sleepy until 3 in the morning and they don’t want to wake up before 12 o’clock in the afternoon. The key is to take it 5 or 6 hours before you go to sleep. Over-the-counter sleep aids such as Tylenol PM and Benadryl are fine for taking once in a great while, but they definitely lose their effectiveness over time.
- What about people who use alcohol to wind down and fall asleep?
- I would not recommend it. Even though it can help you fall asleep, when alcohol is coming out of your system there’s withdrawal effect which can actually wake you up. You wake up early with your heart pounding!
|Dr. Vensel-Rundo is a neurologist at the Cleveland Clinic who specializes in sleep disorders and treatment.|