woman sleeping on a pillow, dream

People who have trouble sleeping are caught in a terrible double bind. On the one hand they are told that sleep is essential for good health. Without it, people are prone to obesity, hypertension, diabetes, depression and cognitive difficulties. On the other hand, if they decide to use sleeping pills, there are other serious risks to consider.

In the early 20th century, the only sleeping pills available were barbiturates like amobarbital (Amytal), pentobarbital (Nembutal) and secobarbital (Seconal). The trouble with such drugs was that overdoses were lethal. Combining a barbiturate with booze was even more deadly. Marilyn Monroe and Judy Garland were among the victims of barbiturate overdose.

When benzodiazepines appeared in the early 1960s they became incredibly popular. Starting with chlordiazepoxide (Librium) and diazepam (Valium), these drugs were hailed as safer sleeping pills and sedatives. Overdoses were far less likely to lead to death. By 1966, such medicines were immortalized by the Rolling Stones in their song “Mother’s Little Helper.”

To this day, drugs such as alprazolam (Xanax), clonazepam (Klonopin) and lorazepam (Ativan) are prescribed in huge numbers to treat anxiety and insomnia.

The downside of both barbiturates and benzodiazepines is that it can be hard to stop taking them. The body adapts and rebels when the drugs are suddenly discontinued. Withdrawal symptoms of benzos include anxiety and agitation, irritability, impaired concentration, panic, insomnia, depression, muscle twitching, sweating and seizures.

When the “Z-drugs” were introduced, they too seemed like an advance for insomniacs. Drugs such as zolpidem (Ambien), zaleplon (Sonata) and eszopiclone (Lunesta) were perceived as more effective and less likely to cause dependence than benzodiazepines.

In recent years, however, evidence has mounted that both benzos and Z-drugs have unexpected side effects, especially in older people. A long-term French study published in 2012 showed a 50 percent increase in the risk of dementia among people over 65 who used a benzodiazepine to help with sleep (BMJ, Sept. 27, 2012).

We also worry about the increased likelihood of a fall among older users of any sleep medications, including the z-drugs. Falls among older people can result in life-threatening fractures.

Researchers from the CDC and Johns Hopkins School of Public Health found that such “psychiatric medications” were implicated in many emergency department visits (JAMA Psychiatry, July 9, 2014). Zolpidem stood out as the drug behind 20 percent of ER visits among older adults.

Morning-after “hangover” can affect anyone. That’s why the FDA reduced the dose of zolpidem for women from 10 mg to 5 mg last year. It’s difficult for drivers to evaluate impairment caused by such medications.

How much benefit do people get from sleeping pills? Dartmouth doctors Schwartz and Woloshin point out that Lunesta helps people fall asleep 15 minutes faster and stay asleep 37 minutes longer than placebo.

So what can people do? Cognitive behavioral therapy can be effective against insomnia. Vigorous exercise during the day, a high-carb snack in the evening or a hot bath an hour before bed may help people fall asleep more quickly. For more informaiton on sleeping pill pros and cons and non-drug approaches to overcoming insomnia, we recommend our Guide to Getting a Good Night’s Sleep.

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  1. amt

    I’ve been using ambien for about 2-3 years. Started with just a few nights a week but now it’s every night. I’m still on the 10mg most nights, but sometimes can only take 5. When I only take 5mg I don’t fall asleep quickly and I wake up at 3am or 4am and have a hard time going back to sleep. I’m also on medication for anxiety and find that I am experiencing some cognitive effects from the sleep aid and other meds. If I do not put my head right down to sleep (watch tv, read in bed) I will get up and do things but not remember in the morning (shop online, eat, not remember what I read). I would like to be able to sleep without help, but when I try it’s so miserable. Reading this article and all the comments makes me want to try harder and deal with the lack of sleep until I can get back into a routine.

  2. JRC

    Mentioned above was an interaction with Warfarin, an anticoagulant. I wish there were some way to know about supplement interaction with drugs. Few, if any, doctors know. Same with pharmacists. Supplements are being used more and more and this information is desperately needed.

  3. Judy

    Joan, I was told by my health care provider to take 1 to 1-1/2 mg of melatonin. (I have a 3 mg pill in half with a pill cutter.) She said not to take it constantly because my body would become dependent on it and I might end up not making any of my own, and also I’d need more and more of it. It is not a medicine but a hormone we all have in our bodies that gets us to sleep. When we get older we often make less of it.

  4. SW

    I have used lorazepam (Ativan) off and on since the 1980’s to help me relax, fall asleep, and stay asleep. I am 69 years old. It is foolproof for me and it never fails me. I have had to increase the dose one time in 32 years, from 1mg. to 2mg. at bedtime. I have no morning hangover. I take it with 100mg. of trazodone (Desyrel, an antidepressant that is sedating), and I usually get a full eight hours of sleep unless I’ve had too much caffeine.
    I have had a lot of anxiety in recent years and I also take lorazepam 2mg. twice during the day as well. That’s 6mg. a day and I am worried about that dose, as I understand that lorazepam can lower serotonin levels in the brain, and thus contribute to depression, and I struggle with chronic depression. Sometimes I forget to take the afternoon dose so you can see that I am not an addict. I don’t crave it. It just helps me so much with stress, which I can’t handle so well as I age.
    I do think I have some mild cognitive deficits from it, as it does have amnesia as a side-effect and often I can’t remember things that I’ve said or things I’ve watched on TV late at night. I would like to give up the daytime doses and just take the bedtime dose.
    Another problem with the daytime doses is that after a few hours I just have to go to sleep because of lorazepam’s sedating property. Just an hour nap will usually take care of it, but I don’t like to get sleepy during the day.
    I will say that lorazepam has been a lifesaver for me and has kept me from being hospitalized several times when I was hysterical from stress or deeply depressed with crying spells/sadness. It helps me get through some rough times and as I have been hospitalized three times in the past 16 years, I don’t want to be hospitalized again. I don’t abuse it; never run out before I’m due to refill the script. I would rather have Xanax or Valium to take during the day as they are not as sedating, but my psychiatrist says he can’t order two different benzos for me and some pharmacies will not fill scripts for two different benzos.
    Lorazepam has a long half-life, too, which is nice, as a pill in the morning will keep me free of anxiety for a good eight hours, and that’s why it works so well in keeping me asleep all night. But there is a drawback to this long half-life.
    Unfortunately, I have noticed that sometimes I have a problem with instant recall, like what someone has just said! Or the very last thing that has happened in a tv show! This scares me and I believe it is the lorazepam causing this scary cognitive deficit, because with its long half-life, I have some in my system all the time if I take it three times a day. I have noticed this in the past few years and it is getting a teeny bit worse over time. Yikes! I will start decreasing the daytime pills and then try some of the things recommended by others in this comment section for the bedtime dose. Thanks for all your great suggestions!

  5. jr

    I have been “addicted” to sleeping products for many many years. I don’t even want to say how long. I am “addicted” to sleep, I guess. Because without ambien I would never sleep!
    I started taking halcion when it was first introduced on the market and I thought it was very good. They took it off the market. I went a few years without anything and returned to my habit of being up and down all night. It takes me a very long time to go to sleep at night. Strangely, I find I can take a one hour nap and fall asleep quickly with a bit of small background noise (tv/fan/etc.) and wake up easily. I have tried to quit ambien and find that it will take me about a week to feel the effect of the drug leaving me. I have very vivid dreams and restless sleep when I don’t take it. I would really like to not take it but I seem unable to go cold turkey completely. I take it every night..5 mg…otherwise I will lie awake for hours or all night. I am 70 years old, female and still working. I am in good health. I take care of my mother who is 99 and in assisted living. I need my sleep! I am considering going off it again but I know it won’t last. In the past year I have noticed that I seem to be having the effects of ambien affecting my daily life. I stay more tired and want to sleep more. I would hate to think it was related to age!!!
    So I don’t know which is better…sleep with ambien aid or no sleep. We both know the answer! I am in search of a more natural way, however. But until I am 99 I may not find it!

  6. JOan

    Any side effects from melatonin? how much is ok to take?
    People’s Pharmacy response: Melatonin is often sold in doses of 3 mg, about 10 times more than the body makes naturally. That seems to be a reasonable dose to try, however. Side effects could include digestive distress or daytime sleepiness. Don’t take it with anticoagulant medicines such as warfarin.

  7. GW

    I am a 56 year old female & have experienced the same sleep issues as most readers, trouble falling asleep and trouble staying asleep. Melatonin didn’t work well for me, valerian did pretty well, sometimes lavender oil on my feet helped. If I was desperate I would take an antihistamine.
    My doctor told me about Phenitropic. It is amazing! I’ve been taking one pill before bed for about a week now & I wake up refreshed & with positive energy. I don’t know if it’s affecting my mood or if it’s just getting some quality sleep but I have been much happier lately.

  8. MR

    I’ve had a lot of trouble with insomnia, and here’s what has helped me:
    1. Exercise in the afternoon, at least 10 min., preferably more, the more aerobic the better.
    2. Eating supper earlier, and not eating anything after supper. Also, having a green salad with supper seems to help.
    3. Taking L-tryptophan before bed.
    4. Taking valerian tincture under the tongue when I need extra help.
    5. Stretching before bed. Also, the yoga position “legs up in the air” seems very helpful.
    6. Taking a magnesium supplement with supper, and drinking rooibos tea, which I’ve heard helps the body absorb magnesium. The rooibos tea also prevents restless legs syndrome for me.
    7. I recently learned that most aged foods (aged cheese, sauerkraut, wine, etc.) contain tyramine, which can stimulate the release of norepinephrine, a stress hormone. Now I eat these foods at lunch, but not supper.
    8. If I cannot get to sleep for over 30 minutes or so, I get up and take more tryptophan and valerian.

  9. lc

    I’ve just been reviewing some journal articles on zolpidem and its’ beneficial effects on Parkinson’s symptoms for a sub-group of people. I think I belong to that group. Also, it has had an almost miraculous ability to ‘wake up’ comatose people in a very small sub-group of patients. Similarly, I experience much improved function if I take lorazepam with my sinemet.
    There is much to study for medical scientists about the way these drugs work in the brain and the GABA neurotransmitter pathway interaction with other neurotransmitters.

  10. Gloria Glenn

    What’s wrong with Melatonin? It’s natural and non-habit-forming. One to three pills occasionally will get you back in the mode of falling asleep.

  11. PMA

    For some people, these drugs really are necessary. There is addiction in my family, so believe me, I was extremely reluctant to start taking clonazepam to help me sleep better. I fall asleep easily, but the quality of my sleep is poor and it was causing growing health problems. During a sleep study it was determined that I jerk my body all night long, every few minutes, causing me to wake up multiple times during the night.
    I would wake in the morning feeling like I never even went to bed in the morning. I do yoga, exercise daily, restrict my caffeine intake and do calming activities in the evening. But without just 5 mgs of clonazapam I am exhausted. I recommend discussing your issues thoroughly with your doctor (hopefully one who doesn’t write prescriptions as a knee jerk reaction to everything) and monitor your health as you take it.

  12. DC

    I have had trouble sleeping since I had children (23) years ago. I can fall asleep anytime but I cannot stay asleep. I have tried everything and I am very healthy get a lot of exercise, still work (a teacher) and I eat very well. So I have no other medical problems other than not being able to stay asleep.
    It began to have negative effect on my teaching and life in general when I woke up at 12am and could not get back to sleep. So I began to take the generic ambien always 5 mg and have never experienced any “sleepwalking” episodes. I go to bed at 9pm get up at 4:30 am (to exercise) and without ambien, I would not have more than 3 hours sleep in a row and then broken and fitful thereafter.
    The most negative thing I experience is a terrible taste from it in the morning and I can’t wait to brush my teeth. This being said, I would like to get off of it eventually because I don’t want to risk things as I get older (am 60 now) but I still have 2-4 more years I want to teach and absolutely need my good sleep. I am hoping that When I retire I am able to gradually take less and less over months if necessary, to get me off of it, perhaps the stress of teaching being gone will be a factor in enabling me to learn to sleep without help. I would be interested to hear from others who have taken it over a period of years and then were able (or not) to get off it it.

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