Americans are using sleeping pills at an alarming rate. Doctors gave out more than 56 million prescription for sleeping pills in 2008.
Why are Americans increasingly using medications to induce sleep? There are many answers to this question. First, insomnia is very common, it affects up to 40% of the population. Chronic insomnia affects about 15% of adults.
Then add the fast pace and high stress pressures of society and you have people who just do not have time to relax and fall asleep.
Insomnia is really defined by a complaint of the quality or amount of sleep for at least three times per week for at least one whole month. A significant number of people believe they have the diagnosis of insomnia if they do not fall asleep upon going to bed. These people may attempt to take a sleeping pill as a form of control of sleep and not really to treat a disease.
Over the past 5 years, new sleeping medications have been developed which have influenced the ways we treat insomnia or the complaint of insomnia. Many of the older sleeping pills interfere with certain stages of sleep. These medications suppress the REM sleep stage(dreaming sleep) and the slow-wave deep non-dreaming sleep stage. Suppressing these stages of sleep interferes with normal brain function and the FDA had previously restricted physicians from prescribing sleeping medications for more than a 2 month period. The newer sleep medications including Ambien and Lunesta do not appear to interfere with these sleep stages and therefore should not interfere with normal brain function. The FDA has subsequently changed the prescribing restrictions for these medications.
There are other concerns with taking sleeping pills including dependence. Patients should be aware of this and should be cautioned against using these medications routinely. Patients with a diagnosis of insomnia should always attempt to fall asleep before taking the sleeping pill. Patients should be cautious not to mix sleeping pills with alcohol or other depressants. Patients should take attempt to take the lowest dose for the shortest possible period of time.
Over the counter sleeping pills use antihistamine types medications that cross the blood-brain barrier and induce sleep by inhibiting the histamine neurotransmitter. This slows brain functions and causes sleepiness. Although these medications can be taken without a prescription, they interfere with memory and can cause forgetfulness.
So what is the answer? Practice good sleep hygiene. This includes avoiding all napping in order to concentrate sleep at night. Get regular exercise and eat dinner at a reasonable time. You should reduce noise in the room while sleeping and avoid caffeine, alcohol, and cold medications. Avoid clock watching while trying to sleep (take the clock out of the bedroom). If not asleep within 15 minutes after going to bed, get up and return to bed when you feel sleepy
If you still want to lie down, do so in another room. These easy techniques cure 80% of all cases of insomnia.
Cristopher Geiler, MD
Nature Medicine 15, 481 (2009)
