The ABCs on More Restful Zzzzzs
Millions have some form of sleep
disorder, from difficulty falling asleep to waking up too early,
according to the National Sleep Foundation. Most people who have
trouble sleeping never seek medical attention, the group says.
That's a trend the pharmaceutical
industry is profiting on as sleep aids have become big business.
A recent Business Week article said the market for sleep
drugs is projected to balloon to $5 billion in 2010 from $2.5
Some critics argue that drug makers
have largely created the market for sleep aids, and that people
don't need medication to overcome insomnia.
"They're wrong," says Dr. Tom Roth,
director of the sleep disorders center at the Henry Ford Hospital
While it's true that not everyone
with insomnia requires sleep aids or should take them, for many
patients the drugs are essential. The drugs are the most common
treatment for insomnia, according to the National Sleep Foundation.
One in four Americans takes some kind of medication for sleep in
any given year, the group says.
On the other hand, Roth said, there's
no conclusive evidence that drugs work better than non-drug sleep
aids, like shifting bed and wake times or altering the way a person
thinks about sleep.
Valium and Xanax were perhaps the
best-known prescription sleeping aids for years. These medications
belong to a family of drugs called benzodiazepines. They're effective
for insomniacs, but they carry the risk of serious side effects,
including depression, aggression and memory trouble. They're also
habit-forming, and long-term use can lead to tolerance of the drugs.
The benzodiazepines have been pushed
aside by two new prescription drugs, Ambien and Sonata, which now
dominate the market for sleep aids. Neither is a benzodiazepine,
though they're not free of side effects.
Ambien, made by Sanofi-Synthelabo,
can cause daytime drowsiness, dizziness, lightheadedness and difficulty
with coordination. Furthermore, the drug's manufacturer doesn't
recommend operating machinery or performing tasks that take extreme
Sonata, from Wyeth-Ayerst Laboratories,
has the same side effects as Ambien. It doesn't appear to be effective
in increasing a patient's total sleep time as its competitor. Nor
does Sonata decrease the number of times a patient may wake up after
Scientists don't know yet if Ambien
and Sonata are addictive, or whether they continue to work over
time. Doctors recommend that patients take the drugs nightly only
for insomnia that lasts a week or two.
Two new sleep drugs are expected
to win regulatory approval in the near future. One is Estorra from
Sepracor. The other is Indiplon, from Neurocrine Biosciences Inc.
Both Indiplon and Estorra are based
on the same chemical structure as Ambien and Sonata, so patients
should expect similar side effects from the new drugs if they're
approved, Roth said. "I know of no drug in any arena which is free
of side effects," he said. "That's the nature of drugs."
Joyce Walsleben, director of the
Sleep Disorders Center at the New York University School of Medicine,
said of the new drugs: "My thinking is, the more the merrier. Not
every drug is right for everyone."
Walsleben believes that modifying
sleeping behavior is ultimately a more solid solution to sleeping
disorders than medication. "There's evidence that's behavior therapy
is better over the long term. But the combination [of drugs and
habit change] is really great," she said. And "clearly, there are
times when medication is the only way to go."
In her own clinic, Walsleben sees
"very few" side effects from Ambien and Sonata. Sonata doesn't always
work, however, and Ambien occasionally leads to confusion. "If you're
up and about with any sedative on board, you're likely to forget
what you're doing," she added.
Many people with sleeping trouble
look to over-the-counter and alternative remedies for help. But
Dr. Richard Schwab, co-director of the sleep center at the University
of Pennsylvania Medical Center, said people who do turn to these
products should be cautious.
"In my experience, prescription sleep
aids are much more effective than over-the- counter sleep aids"
such as those with benadryl and melatonin, he said.
Schwab prescribes Ambien, Sonata
and the benzodiazepine drug sold as Restoril to his patients with
insomnia. He also advocates behavior therapy, though that approach
takes "a lot of time. You need a physician or a psychologist to
sit down and meet weekly or bi-weekly" for months to change poor
sleep habits, he says.
National Sleep Foundation has an excellent explanation as to
why people can't sleep.
Reference Source 101