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Americans May Be Relying Too Heavily on Sleeping Pills

August 8, 2006

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Americans with insomnia may be relying too heavily on sleeping pills instead of trying safer non-drug remedies, according to a new report from Consumer Reports Best Buy Drugs, which recommends that consumers who take sleeping pills do so for the shortest period possible because of the risk of side effects and misuse.

The September 2006 issue of Consumer Reports finds that in 2005 use of sleeping drugs in the United States is generally correlated to the growth in direct-to-consumer advertising of sleep medications. Pharmacists filled 43 million prescriptions for sleep drugs in 2005, a 32 percent increase from 2001. Prescription insomnia medications brought pharmaceutical companies more than $2.7 billion in 2005.

"Sleeping pills are best taken for the short term, and only if they are really needed," said Marvin M. Lipman, M.D., Consumers Union's Chief Medical Adviser. "The advertisements for these drugs may be lulling too many people into believing that these medicines can be taken regularly without consequence."

The report notes that newer sleeping pills do have side effects. These range from minor, such as dizziness and day-after sleepiness, to the more serious, such as cognitive impairment, dependency and rebound insomnia, in which symptoms return or even worsen after the person stops taking the pills.

Additionally, there have been reports of short-term memory loss, sleep walking, and sleep driving when taking sleeping pills; though rare, some people may be susceptible to those effects. Combining sleeping pills with alcohol may aggravate such rare effects.

The report urges people to talk with their doctors about whether they really need a pill. People who have chronic insomnia -- trouble sleeping three or more nights a week for at least a month -- should try behavioral therapy that improves sleep habits and attitudes toward sleeping and bedtime. Some studies show this treatment provides greater benefits than pills over the long term, though chronic insomnia sufferers may have to occasionally take sleeping pills.

The four newer medicines to treat insomnia -- Ambien and Ambien CR, Lunesta, Sonata and Rozerem -- are effective at helping people get to sleep and stay asleep, but not necessarily better than older, less-expensive drugs for many people who need a sleep aid for a night or two, the report found. Those include non-prescription products, such as Nytol and Tylenol PM, that contain antihistamines, or older prescription sedatives called benzodiazepines, such as Dalmane (flurazepam) or Restoril (temazepam).

The report selected Ambien (zolpidem) as a Best Buy, based primarily on the fact that it is scheduled to become available as a generic in October. Fifteen doses of Ambien now cost around $58; when it becomes generic, that price is expected to decline 50 percent to 70 percent.

"Consumers deserve unbiased, accurate information about how well drugs work, their risks, and whether they're worth the cost. Today's drug ads drive up health-care costs, overstate the value of pills, and underplay the dangers of new drugs that have not been proved safe over time. The pharmaceutical industry should stop the hype and give consumers additional and more relevant facts," Consumers Union's President Jim Guest said.

The Consumer Reports article cites the recent ad blitz as a factor driving the sales of sleep drugs. For example, Lunesta's manufacturer, Sepracor, which introduced the drug in April 2005, spent $227 million on advertising that year. Prescriptions for Lunesta totaled 98,471 in April 2005; by December, that number more than quadrupled to 477,877.

Lunesta was the most frequently advertised prescription drug in the United States last year, likely prompting the market leader, Ambien, to buy more advertising time and inundate consumers with sleep drug advertisements. Ambien is the 14th-most prescribed drug in the country.

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