Insomnia is a fairly common condition. About 10 percent to 15 percent of adults in the U.S. say they have persistent problems falling or staying asleep, and getting a good night’s rest. And a third to half of adults say they have at least one episode of insomnia per year. Insomnia can strike people of any age, including children. But older people are more likely to have trouble sleeping.
Insomnia is not a disease. Doctors and sleep experts define three levels of insomnia: (1) transient, (2) intermittent short-term, and (3) chronic. Most people have had transient insomnia at some point in their lives. It can be caused by any number of things. Intermittent and chronic insomnia can be more serious and deserve the attention of your doctor. Insomnia can have serious health affects.
However, there is concern that the newer sleeping pills are over-prescribed and inappropriately prescribed. For several years they have been heavily advertised both to doctors and consumers, which may have led to excessive use. At the same time, studies show that chronic insomnia is under-treated, with fewer than half of the people who need help getting it.
Not all cases of insomnia require treatment, but if you and your doctor decide it is the best course of action for you, there four drugs used to treat insomnia – zolpidem (Ambien and Ambien CR), eszopiclone (Lunesta), ramelteon (Rozerem), and zaleplon (Sonata) – have been widely promoted to both doctors and consumers.
According to a recent Consumer Reports Best Buy Drugs report on drugs to treat insomnia, while effective, these medicines are not necessarily better than older, less expensive drugs for many people who need a sleep aid for a night or two. For example, nonprescription drugs containing antihistamines (Benadryl, Nytol, Tylenol PM, and Sominex) and older prescription sedatives called benzodiazepines may work just as well. Among the benzodiazepines approved as sleep aids are estazolam (ProSom), flurazepam (Dalmane), and temazepam (Restoril).
However, we recommend that both the older and newer sleeping pills be taken more judiciously and less often than appears to be the current pattern of use by millions of people in the U.S. There are two main reasons for that advice:
• People with only mild insomnia problems may be relying too heavily on pills and not trying to address their sleep problems with non-drug measures.
• All insomnia medicines have side effects, can cause dependency, and even worsen your sleeping problems when abused, misused, or taken too often. The possible side effects include daytime sleepiness, cognitive impairment, dizziness, unsteadiness, and rebound insomnia. Sleep-walking, sleep-driving, memory lapses, and hallucinations have also been reported.
People with persistent, chronic insomnia – three or more nights a week for months on end – do need treatment. We advise behavioral therapy that improves sleep habits, possibly combined with cautious use of sleeping pills. You should also know that many prescription and nonprescription drugs – such as steroids, certain pain relievers, caffeine pills, and decongestants – can also trigger insomnia.
For the average person seeking short-term help – for a few nights – we suggest trying an over-the-counter sleep aid first. If that doesn’t work, our comparison of the newer drugs led us to choose zolpidem as a Best Buy. This is the less expensive generic version of the drug Ambien. Fifteen pills cost $10 to $35, depending on dose and where you buy it.
Finally, there is one non-drug treatment alternative that has proven quite effective in treating insomnia. It’s called cognitive behavioral therapy, or CBT. Behavioral therapy involves getting help from a therapist (one trained in CBT) to learn a new set of behaviors around sleep. Studies have found that behavioral therapy is effective--helping 70 percent to 80 percent of people with chronic insomnia--and several studies have found that it works better than sleeping pills alone. In other studies, a combination of the two has helped most.
Interested in more information? Read the full analysis: Consumer Reports Best Buy Drugs Report on Drugs to Treat Insomnia.
