An expert in sleep and aging has said that “it’s extraordinarily rare to find an old person who actually requires [sleeping pills].” Yet the risky pills are still in widespread use, even though evidence keeps accumulating that they cause considerably more harm than good. The federally funded Drug Abuse Warning Network recently reported that in 2010, the latest year for which data were available, 19,487 U.S. emergency room (ER) visits involved the use of just one sleeping pill: zolpidem...
An expert in sleep and aging has said that “it’s extraordinarily rare to find an old person who actually requires [sleeping pills].” Yet the risky pills are still in widespread use, even though evidence keeps accumulating that they cause considerably more harm than good. The federally funded Drug Abuse Warning Network recently reported that in 2010, the latest year for which data were available, 19,487 U.S. emergency room (ER) visits involved the use of just one sleeping pill: zolpidem (AMBIEN, AMBIEN CR, INTERMEZZO, EDLUAR and ZOLPIMIST). This was three times more ER visits than were associated with zolpidem drugs in 2005. About two-thirds of the patients were women, and almost three-quarters were 45 or older (with those 65 or older accounting for one-third of all visits).
Zolpidem is one of the three so-called “Z drugs,” or nonbenzodiazepine hypnotic drugs used to treat insomnia (the other two being eszopiclone [LUNESTA] and zaleplon [SONATA]). All three are categorized as Do Not Use at WorstPills.org. In the last 12 months, 42 million zolpidem prescriptions were filled, 98 percent of which were for the generic. Sales of the drug totaled $475 million.
WorstPills.org also has categorized all of the benzodiazepine sleeping pills/tranquilizers as Do Not Use because of their many risks, including addiction and serious impairment of multiple cognitive and physical functions. These drugs include amitriptyline and chlordiazepoxide (LIMBITROL), alprazolam (NIRAVAM, XANAX, XANAX XR), chlordiazepoxide (H-TRAN, LIBRITABS, LIBRIUM, MITRAN, POXI), clorazepate (GEN-XENE, TRANXENE), diazepam (DIASTAT, DIAZEPAM INTENSOL, VALIUM), estazolam (PROSOM), flurazepam (DALMANE), halazepam (PAXIPAM), lorazepam (ATIVAN, LORAZEPAM INTENSOL), prazepam (CENTRAX), quazepam (DORAL), temazepam (RESTORIL), triazolam (HALCION), oxazepam (SERAX), clonazepam (KLONOPIN), and chlordiazepoxide and clidinium (LIBRAX).
Most adverse effects occur with both the Z-drugs and the benzodiazepines and take place much more frequently than those leading to ER visits. These include driving impairment, dizziness, anxiety, depression, suicidal ideation, confusion, memory loss, dementia, amnesia, addiction with withdrawal symptoms, falls and hip fractures.
What You Can Do
An excellent review of nonpharmacologic approaches to managing insomnia, published in the journal Age and Ageing in 2003, offers suggestions that are far more sensible, less dangerous and less expensive than reliance on prescription drugs. As the authors state, “Non-pharmacological treatments not only cause fewer side effects, but they can sustain long-term improvements more successfully than pharmacological treatments.” The suggested approaches include:
Stimulus control including going to bed only when you feel tired and using the bed only for sleep and sex. If you don’t fall asleep within 20 minutes, leave the room and return only when you feel sleepy, repeating this as often as needed. It also helps to rise at the same time every morning, regardless of how much sleep you got the night before. Use an alarm clock if necessary. Avoid napping. (If you have to take naps, make sure you do so before 3 p.m. and that the total time napping does not exceed an hour.)
Sleep hygiene education including avoiding the use of caffeine products, such as tea, coffee or chocolate; nicotine; and alcohol, especially later in the day. Avoid heavy meals within two hours of bedtime. To prevent frequent nighttime urination, don’t drink fluids after dinner. Avoid stimulating environments after 5 p.m. Establish a bedtime routine that includes relaxation techniques. Create an atmosphere conducive to sleep, including a comfortable temperature, a darker room, and an extra mattress added to an uncomfortable bed. When in bed, relax and think pleasant thoughts to help you fall asleep. Pursue regular physical activity, such as walking or gardening, but avoid vigorous exercise too close to bedtime.