Did you know that 48% of Americans suffer from regular bouts of insomnia and that this number is rising? In fact, prescription of sleeping pills has gone up by 60% since the year 2000. It is thought that the market for sleeping pills may further increase to $3.8 billion in the near future. After all, when tossing and turning in the middle of the night, popping a pill seems like a great idea. But is it?

Perhaps not. Although the pharmaceutical industry would like us to believe that these medications are perfectly safe, more balanced research indicates that they are not. (The "odds ratio for finding results favorable to industry in industry-sponsored trials was 3.6 times as high as in non-industry-sponsored studies.")

So, let's consider the two most commonly prescribed classes of sleep-inducing drugs: benzodiazepines and non-benzodiazepines. Anti-histamines are also used for treatment of insomnia, but won't be covered here.

Benzodiazepines are prescribed for both anxiety and insomnia. They include drugs such as Xanax, Klonopin, Valium, Lorazepam, Temazepam and Ativan; four of these are in the top 100 of commonly prescribed medications. At least 11-15% of Americans have used benzodiazepines in the recent past and the drugs are considered "safe," despite the fact that they are well known to be addictive. Moreover, benzodiazepines can cause amnesia, depression, disinhibition, and possibly even cancer. Are these acceptable risks for treatment of short-term insomnia? You decide.

But, the problem is that insomnia is often not a short-term ailment; about 2% of our population have used these drugs for years. Therefore, a recent prospective study indicating that benzodiazepines can increase risk of dementia in the elderly by 50% should be of great concern. Admittedly, effects on younger people were not studied, but, make no mistake, the chemicals in the brains of the elderly and the rest of the population are essentially identical. Old people are not a different species. Therefore, it would stand to reason that the risks of sustained use of benzodiazepines in younger people may be similar to what occurs in the elderly. The fact that it appears that the adverse effects of benzodiazepines on cognition may not even be reversible makes sleepless nights seem preferable to use of these medications.  

So, let's consider the non-benzodiazepines, which are more targeted and are only prescribed for insomnia. These include medications such as Ambien, Lunesta, Sonata and Imovane. They do not appear to be as addictive as the benzodiazepines (some users would disagree), but can have very serious side effects. For example, Ambien has been shown to be associated with strange behaviors such as sleep-walking, sleep-eating, and sleep-driving.  When this is combined with the total amnesia that sets in about 10 minutes after taking the drug, the consequences can be devastating. You do things you would rather not do and do not remember that you did them. The patient safety sheet also warns about side effects such as depression (more than doubles the risk), decreasing cognitive performance, and reductions in coordination. Ambien has not yet been evaluated for long-term use, so it is recommended that it be used for less than ten days at a time. But, the fact is that many patients have been on non-benzodiazepines for years. Could permanent damage result? It seems likely.

This hypothesis appears to be supported by a recent paper published by the British Journal of Medicine showing that regular use of sleeping pills, whether benzodiazepines, non-benzodiazepines, or just anti-histamines, is associated with a fourfold increase in risk of death. Now, we know that association does not equal causation. After all, as some speculate, it may be that the insomnia is a symptom of a serious ailment that is being masked by use of sleeping pills. However, the authors took care to balance the study participants for health, age, and background, so it is highly unlikely that it is only their health, and not the sleeping pills in themselves, that is causing the increase in death rate.

As is often the case, it seems that, if at all possible, the pill-free regimen is best. Sleep hygienists recommend that, if a person suffers from insomnia, a physician should evaluate them for causative conditions. Then, they should follow these simple steps. 1) Be sure that their bed and bedroom are only used for sleeping. 2) Avoid caffeine. 3) Decide not to worry while in bed. It may help to write the worries down. 4) Eat right and exercise. 5) Don't nap and don't go to bed when not tired.

Finally, if you suffer from insomnia, remember that eventually you will go to sleep. And you will wake up with less amnesia, depression, dementia, cancer and regrets than if you had popped that pill.  

Note: AITSE provides information only. For medical advice, see your physician.