Is Sleep Medication Overused?

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Probably, but there is not a lot we can do about it on a society-wide level.  The medicines are invaluable and although responsible people will try to avoid them or limit their use, the quick fix of a sleeping pill is too appealing to resist for so many insomniacs and doctors.

We are not anti-medicine at Tuck; there is nothing wrong with responsible use of medicines to help people get to sleep.  But it is impossible to not see the temptation for overuse – temptation that affects doctors, patients, and pharmaceutical companies.

Overprescription is a common barb aimed at antidepressants and antibiotics.  Although concerns about hypnotics makes fewer headlines, it exists among thoughtful members of the medical community.

Drugs are safer these days, but…

The addiction problems that sleeping pills of decades ago – barbituates – posed isn’t around.  Modern prescription hypnotics can be habit-forming, but not nearly as much as barbituates were.  They are also safer and rarely cause trauma from overdoses.

Our modern system has controls, but human weakness and ignorance causes a breakdown.  One problem is that the public doesn’t understand that many drugs are intended to be used only for a limited time.  They might not induce dependence in the short run, but they are habit-forming in the long run.

The downside of all sleeping pills is modification to the natural sleep cycle.  The patient may be so grateful at finally getting a good night’s sleep that he or she ignores the morning grogginess.  The downsides of hypnotic use – sleep inertia resulting in drowsy driving, etc. – are well known and anyone taking drugs should be cognizant.

If a patient does get addicted to sleeping pills, it can be tough to recover. Stopping use can result in withdrawal symptoms similar to those experienced by alcoholics who quit alcohol.

Towards even less addictive treatments

One way to manage sleeping pill usage is to vary them.  Move from one type to another.  Or go on periodic “drug holidays”.  Do this with the knowledge and approval of a doctor.

The introduction of Lunesta several years ago caused excitement among Wall St. analysts because Lunesta was the first prescription sleeping pill the FDA did not require to be labeled for short-term use.  Other z-drugs are typically approved for a few weeks at most.  Drugs to treat chronic conditions are a source of growth for the pharmaceutical industry.  While other z-drugs and benzodiazepines were labeled for short-term use, they were often used over longer periods, often with the consent of doctors.  The feeling was that an explicit approval from the FDA for long-term use for Lunesta would remove further barriers to prescription.

Non-drug methods of alleviating insomnia are preferable, but either may not be effective or may be cost prohibitive (CBT).

One sign that a person may be prone to problem is if he or she has an addictive personality and has had problems with other types of medications. It is worth noting that the webpage for the National Institute for Drug Abuse lists several abused drugs and none of the common sleep aids are on the list, although drugs that are rarely used to promote sleep (benzodiazepines and opioids) are.

Overuse of benzodiazepines and z-drugs is a concern in Europe and public health campaigns aimed at reducing usage have not been successful. Since prescription melatonin has been introduced and covered by health plans, however, rates of use of those other drugs have fallen.

More Use

The U.S. federal government’s National Health and Nutrition Examination Survey found 4.1 percent of US adults took a prescription sleep aid in the past month. That’s about 9 million people. Women tend to take these drugs more than men, and older people in greater numbers than younger people. Non-Hispanic white people are more apt to take them than black or Hispanic people. A Thomson Reuters Research Brief announced prescription drugs among those aged 18 to 24 tripled from 1998 to 2006, although the government numbers show usage among young adults is much lower than among the middle-aged and elderly.

Space

NASA typically schedules 8.5 hours per 24 hour period for sleep, but a study shows the average astronaut gets about 6 hours. Being in space is so unusual that it messes up sleep schedules. 75% of astronauts on the shuttle took hypnotic drugs. A quarter of individuals stationed on the International Space Station likewise took sedatives.

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