Safer use of sleeping pills

The recent FDA request for stronger warnings about sleeping pills makes one wonder how safe these medications are.  Should I take them at all?  How often?  What should I watch out for if I do take them?

Until very recently no sleeping pill was approved for long-term use due to fears of impairment and addition.  Recently Ambien CR and Lunesta have been approved for long-term use and at the same time prescriptions for sleeping pills have increased tremendously.  Some of this is due to direct to consumer advertising.  I believe that the large numbers of people taking these agents is the reason that these relatively rare side effects have emerged.   Generally they are probably safe.  However, for all the hype about how great sleeping pills are, few people really look at the down side.  If you want a different perspective, see HERE. 

In general, almost all sleep specialists believe that nightly use of any sleeping pill is a last resort.  It should only come after trials on other medications, patient education, cognitive therapy, and intermittent sleeping pill use.  At that point, nightly use might be appropriate with close monitoring from a physician, understanding that there are risks.

If you are taking or are considering taking a sleeping pill, here are some suggestions to make it safer:

1. When starting a sleeping pill always take the lowest dose at home, preferably with someone present.  Do not take it for the first time in a hotel, at a friend’s house, or on a plane.  (Next blog:  The Ambien traveller arrested for bizarre behavior, a true story.)

2. Do not combine any sleeping pill with other sedative medications including certain antidepressants and certainly alcohol.

3. Make your environment safe if you do try a sleeping pill.  Be sure that you could not wander out of the house or even your room.  (Don’t’ sleep on the top bunk.)

4. Be aware of what others notice, or be sensitive to possible signs that you were sleep walking.  For example, early signs of a problem might include forgetting a conversation or forgetting that you walked to the kitchen.  If there are such signs, reduce the dose.

5. Take the sleeping pills intermittently, such as 1 to 5 times per week.  Everyone can stand a bad night of sleep—if you think you can’t you need cognitive therapy.

6. The older you are the lower dose you need.  So if you’ve been on Ambien for 10 years, the level in your blood now is higher than when you began:  Reduce the dose.

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