Healthy Skepticism Library item: 6059

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Publication type: news

McVicar N.
A sleep aid wake-up call
Seattle Times 2006 Sep 10
http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=healthsleep10&date=20060910&query=sleeping+pills

Full text:

A sleep aid wake-up call

By Nancy McVicar
South Florida Sun-Sentinel

In the ads for the new sleep drug Lunesta, a pale green luna moth – they’re nocturnal – floats peacefully across the TV or computer screen, hoping to lure you into asking your doctor to prescribe the medication.

What the $60 million ad campaign doesn’t mention is that there’s little research showing Lunesta works any better than prescription sleep aids already on the market. Also, sleep experts say there are drug-free ways to get a good night’s sleep.

Insomnia plagues an estimated 70 million Americans, according to the National Institutes of Health, and many of them seek prescriptions as a quick route to a good night’s sleep.

“I try to encourage people not to use these medicines because of side effects,” said Dr. Glenn Singer, who leads the sleep disorders center at Broward General Medical Center in Fort Lauderdale, Fla. Singer said some people become dependent on the medications.

“We don’t call it addiction, we call it habituation,” he said. (Others call it dependency.) “We want people to learn how to sleep better, and there are other ways of doing that.”

Sleep specialists say lifestyle changes can be very effective in treating insomnia. Neal Nay, manager of the sleep disorders center at JFK Medical Center in Atlantis, Fla., recommends simple approaches, such as getting out of bed and reading until you’re drowsy, to get a good night’s sleep.

“We encourage (insomniacs) to read something kind of boring, not a romance novel or a suspense novel,” he said. “Teach yourself Latin. That should make you drowsy.”

Despite such advice, the appeal of sleep medications remains strong.

Sales totals not a snoozer

Sales of Lunesta, launched in early 2005, have been brisk. Ambien and its latest version, Ambien CR, are big sellers, too, along with Sonata and other prescription sleep medications. Americans filled more than 35 million prescriptions for sleeping pills in 2004 at a cost of $2.1 billion, according to a study earlier this year by managed-care company Medco Health Solutions.

People 65 and older are most likely to get sleeping-pill prescriptions, Medco found, based on an analysis of prescription-drug claims of 2.4 million Americans between 2000 and 2004. But use of the pills in adults 20 to 44 doubled during that four-year span, the study showed.

Consumer advocates say Lunesta and Ambien are the latest in a series of medications that have been marketed directly to consumers since federal law was relaxed to allow such sales tactics by pharmaceutical manufacturers in 1997.

Often, new treatments are touted as better than existing options, which may drive patients to pressure their doctors to prescribe them.

While doctors say there are circumstances in which people can benefit from taking a sleeping pill, many causes of insomnia are tied to lifestyle choices: drinking caffeinated beverages with dinner or later, eating chocolate or exercising right before bed.

Several forms of disorder

Insomnia takes a few forms – difficulty falling asleep or falling asleep but waking early and then not being able to go back to sleep, or waking frequently, said Dr. Laurence Smolley, medical director of the sleep disorders center at Cleveland Clinic Florida.

People who wake frequently in the night may need to be studied to determine whether they have sleep apnea, a condition in which the throat closes and the person stops breathing and awakes gasping for breath or another condition called periodic limb movement, in which the legs or arms move involuntarily, sometimes jerking the person awake. Smolley said both conditions are treatable.

He said he would temporarily prescribe a sleeping medication to help people fall asleep under some circumstances, such as after a death in the family, but in general he tries to get the insomniac to learn new behaviors or unlearn old ones.

“(Sleeping pills) are big business because there’s a lot of insomnia, but I have a bias,” Smolley said. “There’s increasing (medical studies) that support the following the statement: Insomnia, depression, and anxiety all can be treated by behavioral therapies.”

A study published late last year in the Annals of Internal Medicine compared patients who tried behavior changes with people who used sleeping pills to fall asleep. The Harvard Medical School researchers found behavioral therapy worked better than medication in a group of young adults and middle-aged adults.

An analysis earlier this year of six clinical trials also found benefits for older patients using the drug-free approach. The Cochrane Collaboration, an international group of researchers who analyze and assess medical evidence based on clinical trials, found that people 60 and older benefited from behavioral therapy.

“When the possible side effects of (sleeping pills) are considered, there is an argument to be made for clinical use of cognitive-behavioral treatments,” the researchers said.

Smolley teaches his patients relaxation techniques and reminds them they can’t force themselves to go to sleep.

“People have to be reminded sleep is not an Olympic sport,” Smolley said. “You can’t turn your mind off like a computer, but you can turn your mind on to something relaxing. Think about walking on the beach or walking in the woods. Enjoy this fantasy and allow yourself to go to sleep.”

Copyright © 2006 The Seattle Times Company