Healthy Skepticism Library item: 3840

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Publication type: news

Cassels A.
Sleeping pill war will keep you awake
Common Ground ( Canada) 2006 Mar 4
http://www.commonground.ca/iss/0603176/cg176_cassels.shtml

Notes:

Ralph Faggotter’s Comments:

Alan Cassels takes a shot at the promotion of insomnia.

Full text:

Sleeping pill war will keep you awake

by Alan Cassels

While it may surprise some Common Ground readers that I’m an ex-military officer, it shouldn’t come as a surprise then that I recently woke up at three in the morning with the chilling words “collateral damage” ringing in my cranium.
This is standard-issue, military techno-speak, and a term that you’d hear in a bunker along with “friendly fire” or “soft targets.” It refers to those unfortunate souls who happened to get killed or maimed, not by something they did, but because they happened to live close to something someone thought was a good target.
The reason this term came to me, flinging my eyelids open at zero-dark-three-zero in the morning, is because it dawned on me that south of the border, Big Pharma is in the midst of a drug war over the market for its newest sleeping pills. And more of us unsuspecting and occasional insomniacs are going to get hit with shrapnel as the battles are waged with increasing ferocity.
The war in question is between three rival companies, launching missions for new patients for sleeping pills. One astute financial analyst thoughtfully tells us this is going to “…drive the $3.8 billion insomnia market to new heights.” Okay. That kind of language snapped my synapses wide open.
Ambien, (zolpidem tartrate) the market leader, holds the high ground, selling like hotcakes under the premise that it is “safer” and not dangerously addictive like the older benzodiazepine drugs. Those drugs have had such bad press, because, how can I say this politely, some docs think they’re as addictive as crack cocaine.
With a comfortably wide niche in the market, Ambien has been a stalwart in this war for more than 12 years, accounting for more than 70 percent of the sleeping pills ingested nightly by American insomniacs. Yet, sensing that its high ground was under assault, Ambien’s maker, Sanofi-Synthelabo, recently invested more than $50 million in direct-to-consumer, TV and print advertising, proclaiming its overwhelming firepower and threatening any competition with the gonads to take it on.
Two upstarts, however, have appeared on the battlefield: Lunesta, (eszopiclone) marketed by Sepracor and Sonata (zaleplon), produced by King Pharmaceuticals. Lunesta’s niche is that it’ll be the one for people – I guess, like myself – who “wake up too early.” Imagine that! A sleeping pill that doesn’t actually put you to sleep but is intended to keep you there. We’re hoping its effects wear off before you have to drive to work.
Sonata does the opposite. One ad reads, “If you’re still awake, it’s not too late for Sonata,” and goes on to claim that “Sonata is best for busy patients, who don’t have time to sleep eight hours a night, yet turn in late.” Now that’s a new twist: a sleeping pill that zaps you to sleep as soon as you’ve decided that the late night talk shows are a bit too lame and you need to slam in a few ZZZs before that big, important meeting the next day.
Now, I’m not saying that some people, some of the time, won’t benefit from being chemically induced to enter dreamland. That’s what those drugs should do, but only in emergencies, and only very, very, occasionally. Yet most of us live nowhere near the blast range of a serious sleeping problem. The question of their addictive nature, however, is still open to question, with some doctors saying it’s “same old, same old” with the new drugs. That’s right: Crack.
The key warhead being used to try to convince more and more of us that we suck at sleep and could use some convenient pharmaceutical enhancement is none other than the handy little self-diagnostic test.
Take this handy little sleep IQ quiz:
Do you watch the late show because you can’t fall asleep?
Are you often cranky?
Do you eat spicy foods for dinner?
Do you experience a lot of stress in your life?
And so on.
Answer a couple of those in the affirmative and you are set to become a new patient for one of these drugs. The punch line of any self-diagnostic test, by the way, is as blasé and predictable as they come: “See your doctor.” After all, who else has the power to send you to sleep heaven with a “safe,” monitored, prescription drug?
And then there is the perennial disease mongering, promulgated by our friendly media always striving to do the right thing. Some handy examples from the US media:
CNN: “Three out of four Americans have sleep problems.”
MSNBC: “Too many of us don’t get enough sleep.”
Chicago Tribune: “A good night’s sleep is a pipe dream.”
Hmmm.
But are we really a nation of zombies, as the press would have us believe? Are we really in the midst of an epidemic of sleeplessness? Are we putting ourselves in danger, daily, trying to stay awake while driving or operating heavy machinery, like a photocopier?
I beg to differ. Yet where can we turn for trusted advice on this state of affairs?
The National Sleep Foundation, that’s where. And it has this to say: “Seventy million Americans (or about 7.5 million Canadians) suffer from sleep problems.” It also states that three-quarters of American adults frequently experience some sort of sleep problem, including waking at night or snoring, and that one-quarter of us report that sleep problems have some affect on our daily life.
Me? I suffer from a bad case of military terminology that jolts me awake in the middle of the night. It doesn’t help that deadlines (such as the one for my monthly column) are whizzing by.
But what about the rest of you whiners? Sure, we’re an overactive, plugged-in, instant-gratification, pill-for-every-ill bunch. And many of us are overactive Type A personalities, who multi-task and sword-juggle our way through life. Should we be whingeing constantly about how much our minds buzz in the middle of the night?
But let’s take a closer look at who funds the insomniac propaganda. A little digging uncovers groups like the American Academy of Sleep Medicine and the National Sleep Foundation, partly funded by…well, surprise, surprise – it’s the very makers of the drugs who are launching tactical nuclear warheads into the general population, hoping more of us show up at our doctors with incurable sleeplessness and demanding a script.
This gem comes from the National Sleep Foundation’s website:
“Through its Ambien brand, Sanofi-Synthelabo has provided unrestricted support for National Sleep Awareness Week and other NSF initiatives, and has contributed generously to other programs that have advanced the fields of sleep science and sleep medicine, as well as public awareness of the importance of sleep and the need to recognize and treat sleep disorders, including insomnia.”
I should add that the pharma-ceutical industry is not alone in disease mongering our ability to saw a few logs at night. The major manufacturers of “sleep products,” such as duvets, mattresses, beds and other pornaphrenalia that send us into dreamland, have their fingers in the cookie jar as well.
So, what’s a guy to do, snapping to attention at three in the morning?
Sleep hygiene is the answer. Things like getting enough exercise, not eating full-sized pepperoni pizzas or not chugging a quart of gin before tucking in for the night seem to be, at least, a place to start. Fresh air, good covers and a dark place to sleep also help.
But do you still have trouble sleeping? All I can say is don’t become collateral damage in a war that we’ll not win. Do as I do. Get up. Be productive. Write letters to your local newspaper telling them how much you resent being turned into a patient by Big Pharma’s wars. Anything. Don’t submit.
If all that fails, put on your flak jacket and keep your head down.
The shrapnel is flying.

Alan Cassels is the co-author of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All into Patients, and a drug policy researcher at the University of Victoria. He has spent most of the last 10 years studying how clinical research about prescription drugs is communicated to policy makers, prescribers and consumers. He is also the founder of Media Doctor Canada (www.mediadoctor.ca), which evaluates the reporting of medical treatments in Canada’s media.

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