Millions of Americans are prescribed sleeping aids such as Ambien, Lunesta, and Sonata very year. These sleep aids make up a two-billion dollar market. These drugs are known as the “Z-drugs,” or the non-benzodiazepines.
“Everyone is looking for something to help them sleep,” said Lawrence Epstein, an instructor at Harvard Medical School and medical director of Sleep Health Centers, a network of medical centers and clinics for people with sleep disorders.
What are Z-drugs?
The Z-drugs, which include Lunesta, Ambien, Imovane, and Sonata, are benzodiazepine receptor agonists. That means they work in a similar way to the benzodiazepine drugs inside the brain. They are GABA agonists, meaning they somewhat mimic the action of gamma-Aminobutyric acid, the inhibitory neurotransmitter, and thereby induce sleepiness. Developed in the late 1980s, these Z-drugs are now the preferred sedative hypnotic drugs for the treatment of insomnia. In general, these drugs are recommended for short-term use (7-10 days), and treatment should not exceed four weeks.
Sounds safe, right?
Even though the risk for rebound insomnia, dependence, and tolerance is lower with non-benzodiazepine hypnotics than with benzodiazepine drugs, these drugs are still subject to abuse. In any case, no hypnotic should be taken for more than 7 to 10 days or at higher than the recommended dose without a doctor’s approval. The problem is that most people taking these sleeping aids do not just do so for the recommended 7 to 10 days.
“Sleep medications are best used for a short-term intervention for patients where you can break their cycle, reset their sleep pattern and get them back on a more appropriate schedule,” Epstein said. “With short-term use under the direction of a clinician, sleep aids should not cause big problems,” Epstein said, “but dependency and withdrawal effects remain concerns.”
When patients stop taking sleeping pills, doctors say, they should do so gradually because they could experience “rebound insomnia,” where their sleep problems get worse than they were before. Also, patients should be aware that the most effective tactic is to attack whatever physical or emotional problems are causing sleeplessness.
“Sleeping pills are not going to cure you,” said Charles Cutler, an internist in Norristown, Pa. ”It’s not like a shot of penicillin and you move on with your life. The overwhelming percent of patients with sleep disturbances have emotional concerns that are bothering them and keeping them awake. There may be other things going on in your life that we have to fix.”
Cutler says he feels comfortable prescribing sleep aids only when he has talked with patients about a variety of possible causes for their insomnia: an old mattress, watching television before falling asleep, sleep apnea, weight gain, financial strain, relationship problems, etc.
“We live in a society where people want sort of quick answers and quick solutions to sometimes complicated problems,” Cutler said. “Sleeping pills are a short-term Band-Aid.”
In summary, sleeping pills may be helpful for the short-term, but sleep problems can only be rectified long-term if you work to correct the underlying issue causing the insomnia.
- Tamura, Leslie. Z drugs keep sleep-aid market awake. Washington Post. 15 February 2011. Web. 7 January 2013.
Filed under: Alcohol and Drugs, Conditions and Disorders · Tags: ambien, GABA agonists, gamma-Aminobutyric acid, Imovane, inhibitory neurotransmitter, insomnia, Lunesta, non-benzodiazepine hypnotics, rebound insomnia, sedative hypnotic drugs, sleep aids, sleeping pills, Sonata, treatment for insomnia, Z-drugs