Patients who come to see me because of trouble sleeping often ask about sleeping pills. This has especially been true since Lunesta (eszopiclone) came on the market a few years agoâ€”and its makers launched a big television advertisement campaign for the sleeping pill. In the article below, Dr. Celeste Robb Nicholson, the editor in chief of Harvard Women's Health Watch, discusses Lunesta in great detail. Hopefully this will answer some of your questions about whether itâ€”or any sleep medicationâ€”is right for you.
Lunesta (eszopiclone) is the newest member of a class of prescription sleeping pills called nonbenzodiazepines, which includes zolpidem (Ambien) and zaleplon (Sonata)â€”also known as Z drugs. These drugs have risen rapidly in popularity, overtaking benzodiazepine medications such as lorazepam (Ativan) and temazepam (Restoril). One of the problems with the older benzodiazepine drugs is that people develop tolerance if they're taken for longer than 10 days. If you take them regularly, you may need to keep raising the dose to get the same effect.
Benzodiazapines can also cause rebound insomnia (a recurrence of sleep problems after stopping the drug) and other withdrawal symptoms (for example, nightmares resulting from the drugs' interference with REM sleep, the time when we dream most vividly). Nonbenzodiazepines bind more selectively to sleep-regulating receptors in the brain and disappear more quickly from the body, producing fewer side effects. In particular, they're less likely to cause tolerance, withdrawal symptoms, or rebound insomnia.
Lunesta has gotten a lot of attention because it's the only nonbenzodiazepine that's been approved by the FDA for as long as six months of nightly use. Ambien and Sonata, the other drugs in this class, are approved only for short-term use (less than 35 days). A large controlled study found that Lunesta improved sleep quality for up to six months without causing tolerance. For most adults, the standard dose is 2â€“3 milligrams (mg) at bedtime, although older women may do better with just 1 mg. The drug's most common side effects are headache and a bitter taste in the mouth.
The widespread appeal of a sleeping pill that can be used night after night is not surprising. According to the NIH, more than 70 million people in the United States have a sleep disorder, and for 60%, it's a chronic problem. These figures haven't been lost on the pharmaceutical industry. The makers of prescription sleep medications spent more than $61 million to market their pills in 2004 and over twice that in 2005. In an analysis of prescription drug insurance claims from 2.4 million Americans, Medco Health Solutions, Inc. (a health benefits management company) found that the number of adults using sleeping pills doubled between 2000 and 2004â€”and most of the users are women. In the 20â€“64 age group, for example, 58% more women than men used sleep medications in 2004.
There's no question that getting adequate sleep is important for good health. But before you reach for a sleeping pill, be sure you aren't falling prey to advertising that plays on your anxiety about not getting the recommended seven to nine hours of sleep. While sleeping pills can be very helpful for occasional, short-term use, they are not the first line of defense against insomnia. All pills have side effects and may interact with other medications. Even the nonbenzodiazepines can cause some rebound insomnia and changes in normal sleep patterns, which could affect memory and learning in the long run. Lunesta has only been approved for six months of useâ€”not a lifetime of insomnia.
|Good sleep habits |
Â·Â Â Â Â Â Â Â Â Get exercise during the day.
Â·Â Â Â Â Â Â Â Â Avoid alcohol in the evening and caffeine after noon.
Â·Â Â Â Â Â Â Â Â Avoid arguments or stressful conversations near bedtime.
Â·Â Â Â Â Â Â Â Â Don't overeat close to bedtime or go to bed too hungry.
Â·Â Â Â Â Â Â Â Â Put aside the work of the day at least a half-hour before you want to sleep.
Â·Â Â Â Â Â Â Â Â Establish a bedtime ritual that you can follow regularly.
Â·Â Â Â Â Â Â Â Â Retire for the night only when you are sleepy.
Â·Â Â Â Â Â Â Â Â If it takes you more than 10â€“15 minutes to fall asleep, get out of bed; then read in another room, and try again later.
If you have chronic insomnia, the first thing to do is find out if the cause is a treatable condition, such as heart disease, asthma, sleep apnea, restless legs syndrome, depression, or anxiety. Investigate whether something elseâ€”such as alcohol, caffeine, tobacco, or medicationsâ€”is interfering with your sleep. And practice good sleep hygiene (see box, "Good sleep habits").
To wind down for sleep, try a warm bath (as long as hot flashes aren't a problem for you) or a few minutes of reading in a comfortable chair. You might also find it helpful to learn the "relaxation response," a technique developed by Dr. Herbert Benson at the Harvard Medical School.
Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.
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