Sleep Meds Not Always a Dream Come True
By Lisa Larkin, MD, FACP, NCMP, IF
It’s no secret that we – Americans, and especially women – aren’t getting enough sleep. Nearly forty million Americans suffer from sleep problems, including trouble falling asleep, staying asleep or achieving truly restful sleep.
It might be tempting to seek help in the form of a pill, either with a prescription sleep medication or an over-the-counter dietary supplement. But the research tells us to proceed carefully.
Over the past 30 years, sedative-hypnotic medications have gained popularity for their effectiveness. You might be familiar with names like Ambien (zolpidem), Lunesta (eszopiclone) or Sonata (zaleplon).
But what might not be obvious from advertisements featuring fluttering butterflies and the promise of peaceful sleep is the concern about side effects—sometimes severe.
This spring, the FDA required these drugs to carry new “black-box” warnings, the strongest the agency carries. The concern comes after 66 cases were identified of serious injury and death in the past 26 years from individuals taking these medications and then sleepwalking, sleep driving or partaking in other activities while not fully awake.
While these incidents are rare, it is important to note these events can happen the first time a patient takes these medications or at any subsequent dose. They can occur in people with no history of these behaviors or who are taking the lowest recommended dose.
Patients must fully understand all warnings related to these medications. Also, it is extremely important to avoid alcohol when taking them.
Could supplements perhaps be a gentler approach to treating sleep disorders? The data is not clear, and not especially compelling.
In its most recent clinical practice guidelines, the American Academy of Sleep Medicine reviewed some of the more popular supplement sleep aids, including melatonin, L-tryptophan and valerian. Ultimately, it recommended against all three.
Melatonin is often believed to help patients fall asleep more quickly and without lingering symptoms. While clinical trials suggest it could decrease the amount of time it takes to fall asleep by five to nine minutes, melatonin has not yet been the subject of high-quality research.
L-tryptophan’s early studies provided some data to back its use, but a more recent clinical trial provided mixed results. Patients taking L-tryptophan should be carefully screened since it is a precursor of serotonin and concern exists regarding drug interactions.
Valerian has also been widely studied, but not with a methodology that allows results to be applied to the general population. The two largest clinical trials failed to show it provided significant improvements in sleep.
Other sleep aids, including cannabidiol (CBD) and kava, have been found to be well-tolerated, but results regarding effectiveness are mixed and some patients experienced interactions.
Chamomile and lavender are generally deemed safe but not proven to significantly improve sleep.
What to Do?
Insomnia treatment begins with good sleep hygiene, regular exercise habits and management of any underlying health concerns. Biological conditions unique to women should also be considered, including hormonal changes and lifestyle factors.
While sleeping pills might provide relief, important warnings and risks must be understood and usage monitored carefully.
Sleep is vital. Talk to your healthcare provider about the best plan for you.