Study Links Sleeping Pills to Mortality

Sleeping pills lengthen your slumber and may shorten your life, a Canadian report claims. The 12-year study linked hypnotic class sleep drugs and anti-anxiety medications with long-term mortality.

Consumption of sleeping pills or anxiety relieving medications was associated with a 36 percent higher death risk, the study concluded. Respondents to a large Canadian National Survey who said they used the medications at least once a month had a mortality rate of 15.7 percent. Those who said did not use the medications had a rate of 10.5 percent. The results were controlled to person risk factors like tobacco use, depression and physical health.

The study offers no clear explanation of the findings. The results bare resemblance to a study published in the September issue of the journal SLEEP that investigated a possible link between insomnia and long-term death risk. It reported five times as many middle-aged male insomnia patients died over the 14-year study length compared with healthy subjects.

Could the elevated mortality rates associated with sleeping pills be due to long-term insomnia? It is not a stretch to conclude a many of the people who regularly use sleeping pills over an extended period of time also have long-term insomnia.

Dr. Geneviève Belleville, the lead author of the sleeping pill study, offers an alternate explanation. Dr. Belleville speculates the sleeping pills and anti-anxiety medications may cause accidents and promote suicides.

Sleeping pills and anxiolytics impact reaction time, alertness and coordination. Under these conditions, the risk of injury from a fall or an automotive accident increases.

A review shows sleeping drugs may increase the risk of suicide as many as seven times over. Central nervous system inhibitors found in the medications may alter a person’s judgment, making some people more likely to carry out suicidal ideations.

The AASM reports hypnotic class drugs are safe and effect short-term solutions to insomnia when used as directed. Go to bed immediately after taking sleep medications and avoid physical activity, driving, or operating heavy machinery. Never take more than the recommended dose, for risk of serious complications.

Dr. Belleville recommends insomnia patients consider the alternative of cognitive behavioral therapy, the most effective solution to long-term insomnia. The approach helps you change actions or thoughts that hurt your ability to sleep and promote a healthy pattern of sleep.

Image by Zach Armstrong

Learning from Lindsay Lohan, Follow Doctors' Orders for Sleeping Pills

Former teen starlet turned jailbird Lindsay Lohan reportedly was asking for trouble by combining Ambien and several other drugs. A report by the tabloid TMZ claims the troubled actress’s medicine cabinet contained Zolpidem, Adderall and Dilaudid, a potentially dangerous combination. Although CBS News was unable to verify it, the Lohan’s story is an opportunity to talk about responsible use of sleeping pills.

For Lohan, the consequences could have been a lot worse than a 90-day prison sentence. CBS News Chief Medical Correspondent Dr. John Lapook reports combining Dilaudid and Ambien can depress your breathing and cause oxygen in your blood to become dangerously low.

Other potential drug combinations may be a recipe for trouble. Although probation has prevented Lohan from drinking or using illegal recreational drugs, it’s anyone’s guess what she may have been doing before had to wear a monitoring bracelet and take drug tests regularly.

Sleeping pills should never be taken with alcohol. That combination may result in a visit to the emergency room. Other drugs, especially those with depressant effects may lead to similar serious health problems.

The AASM reports Ambien is a safe short-term solution to insomnia… if you closely follow doctors’ orders. Strange episodes of sleep walking, sleep driving or even sleep sex can occur when the drug isn’t used as directed.

Cognitive behavioral therapy may be a better choice for long-term or chronic cases of insomnia.

“Ambien Zombies”, sleepwalking fears and facts

Last night, Fox News Boston aired the special report “Is Ambien creating a nation of zombies?” The segment called attention to dangerous or even deadly sleepwalking episodes linked to the prescription sleep drug Ambien.



While these incidents are a reminder that side effects can occur, millions of people regularly take Ambien and other prescription hypnotics without experiencing any problems.

You can minimize the risk if you take Ambien exactly as prescribed by your doctor, moments before bedtime. Never increase dosage or begin taking additional medications without consulting your doctor. And don’t use alcohol before or after taking Ambien. Allow for a full nights sleep when you take the drug.

The FDA warns in its Medication Guide for Ambien, “You may get up out of bed while not being fully awake and do an activity that you do not know you are doing. The next morning, you may not remember that you did anything during the night.”

The AASM recognizes Ambien as a safe short-term treatment for insomnia. For severe or chronic cases we recommend seeing a board-certified sleep specialist for further treatment options, such as cognitive behavioral therapy. To find a sleep specialist contact an AASM-accredited sleep center near you.

Find out more about Ambien and other sleep medications.

Or follow us on Twitter: twitter.com/aasmorg.

Is Ambien a Miracle Cure for Severe Brain Damage?

Most people who take zolpidem – the generic name for Ambien – have insomnia and want to fall asleep. But can the drug help some people wake from an unconscious state?

For years ReGen Therapeutics in London has been working on a “zolpidem project.” It is developing new, low-dose, non-sedating formulations of zolpidem; the goal is to use zolpidem to reverse “brain dormancy.”

Now the Moss Rehabilitation Research Institute (MRRI) in Philadelphia has announced that it will launch a federally-funded study of zolpidem. It intends to enroll about 100 people who are in a vegetative or minimally conscious state due to brain injury. The study will be led by Dr. John Whyte.

The NINDS reports that people in a vegetative state are unconscious and unaware of their surroundings; but they maintain a sleep-wake cycle and periods of alertness. A person who remains in this condition for more than a month is in a “persistent” vegetative state.

In May Whyte published a study involving 15 people; each person was vegetative or minimally conscious. They were given 10 mg of zolpidem by a feeding tube.

One vegetative participant had a significant response; he became minimally conscious. This effect was repeated in a replication assessment. But the other 14 people showed no improvement.

Some previous studies of zolpidem have yielded dramatic results.

A 2008 report from Stanford described a 35-year-old man with a brain injury; eight months after the injury he was given zolpidem twice a day. This produced an increase in his alertness, speech and movement.

A similar case occurred in Israel. It involved a 50-year-old woman with a brain injury. After taking zolpidem she regained the ability to speak and feed herself. The effect would occur within 45 minutes of taking the drug; it would last for three to four hours before she returned to her former state. The effect was repeatable on a daily basis.

A 2006 study involved three people; each had been in a permanent vegetative state for at least three years. Daily response to zolpidem was monitored for three to six years. The study found a long-term improvement in brain function.

But a 2008 report from the U.K. was less promising. It involved a 44-year-old man; four years after a traumatic brain injury he remained minimally conscious. On zolpidem he showed no improvement; by some assessments his condition worsened.

Exactly how might zolpidem improve brain function? Why do some people show no response to the drug? These questions remain to be answered.

Understanding Unusual Ambien Side Effects

A new study may help explain why some people have unusual side effects when taking the sleep aid zolpidem – also known as Ambien.

Reuters reports that the drug can shut down brain circuits that normally inhibit some activity. This may release the brakes on other brain circuits while you sleep.

“In a way, Ambien is awakening other circuits because the brakes are not in place," study co-author Molly Huntsman told Reuters. “It's a population of neurons that is normally in place to stop activity. We find what Ambien does is inhibit their function to inhibit.”

Ambien is a sedative-hypnotic that is FDA-approved for the short-term treatment of insomnia in adults. The most common side effects include drowsiness and dizziness.

But other unusual side effects can occur. In 2007 the FDA requested changes to the product labeling of all sedative-hypnotics.

One of the proposed changes was to include a warning about the risk of “complex sleep-related behaviors.” Examples include sleepwalking and sleep eating. Rare cases of sleep driving also have been reported.

The FDA-approved Medication Guide for Ambien now states that, “You may get up out of bed while not being fully awake and do an activity that you do not know you are doing. The next morning, you may not remember that you did anything during the night.”

But why do these unusual side effects only occur in some people? Huntsman suggests that something may have happened to their brain circuitry.

It is possible that a previous experience changed their brain receptors. This could affect how they respond to a drug like Ambien.

“A lot of things can change your brain chemistry - stress, alcohol use," Huntsman told Reuters.

The AASM offers these Guidelines for Taking Sleep Medications. Contact your doctor or pharmacist if you have any other questions about taking sleeping pills.

You also should ask your doctor about cognitive behavioral therapy for insomnia. It is a safe and effective treatment option.

Get help for insomnia at an AASM-accredited sleep center near you.

Combining Cognitive Behavioral Therapy with a Medication to Treat Insomnia

For people with insomnia, taking a medication can help break the cycle of sleepless nights. And cognitive behavioral therapy can lead to long-lasting improvements with little risk of side effects. But what happens when you combine these two treatments?

A new study helps to answer this question. The results were published today in The Journal of the American Medical Association.

The study involved 160 adults with chronic insomnia. For six weeks they were treated with either CBT or CBT combined with 10 mg of zolpidem at bedtime. Zolpidem is the generic name for Ambien.

Then the study continued for six months. Some of the people treated with only CBT attended monthly treatment sessions; others had no further treatment. Some participants in the combined treatment group continued with CBT and zolpidem; others continued only with CBT.

Results show that for the first six weeks, both CBT and CBT combined with zolpidem reduced insomnia symptoms. About 60 percent of participants in each treatment group slept better. Treatment eliminated insomnia symptoms in 39 percent of the CBT group and 44 percent of the CBT with zolpidem group. The combined treatment also produced a larger increase in total sleep time.

What was the best long-term treatment? CBT with zolpidem for the first six weeks, followed by ongoing CBT without medication. This method eliminated insomnia symptoms in 68 percent of participants.

The study suggests that a combined approach may maximize the strengths of both common insomnia treatments.

You should never take a sleeping pill without first getting approval from your doctor. A sleep specialist at an AASM-accredited sleep center can develop a treatment plan for insomnia that is best for you.

An Economic Upturn for Makers of Sleeping Pills

Another sign that the economy is affecting our sleep: We’re taking more sleeping pills.

Advertising Age reports that sleeping-pill prescriptions increased seven percent last year. Sales rose even though ad spending dropped by hundreds of millions of dollars.

Sepracor had revenues of $161.9 million for the fourth quarter of 2008 from sales of Lunesta. This was up from $149.8 million for the same quarter in 2007. Full-year revenues were a little more than $600 million in both 2007 and 2008.

But sales aren’t up across the board.

Fourth-quarter net sales of Ambien CR (controlled release) in the U.S. were $170 million for sanofi-aventis. This was down from $190 million in the same quarter of 2007. Full-year sales dropped from $751 million in 2007 to $681 million in 2008.

Full-year net sales for Ambien IR (immediate release) fell to $125 million in 2008. The sanofi-aventis patent for this drug expired in April 2007. Many other companies then received FDA approval to sell less expensive, generic versions of Ambien.

The Boston Globe points out two other reasons why prescriptions may be up.

One reason has to do with safety. Older types of sleeping pills were limited to short-term use for one or two weeks. There was a risk that long-term use could cause addiction. There also was a risk that your body would develop a tolerance to the drug.

But sleeping pills introduced in the last two decades are considered to be safer. Ambien CR, Lunesta and Rozerem all have been approved for long-term use.

A study in the journal Sleep in 2008 found that regular use of Ambien CR for six months is safe and effective. The study was funded by sanofi-aventis.

In 2007 a study in the journal Sleep confirmed the long-term effectiveness of Lunesta. A nightly dose of 3 mg remained effective after six months. The study was funded by Sepracor.

A study in the Journal of Clinical Sleep Medicine in 2007 showed that nightly use of Rozerem was safe and effective over five weeks. The study was funded by Takeda.

The Globe also reports that more doctors are taking insomnia seriously. They recognize that treatment can promote both physical and mental health.

In 2008 a study in the journal Sleep affirmed that primary insomnia is a legitimate disorder. It linked primary insomnia to low levels of the brain chemical GABA. Many of the most effective sleeping pills increase brain activity at the GABA neurons. The study was funded in part by Sepracor.

Read the Guidelines for Taking Sleep Medications from the AASM.

The Curious Case of the Sleep E-mailer

Add e-mailing to the long list of behaviors that can occur during an episode of sleepwalking.

The journal Sleep Medicine has an article “in press” that will appear in an upcoming issue. It describes the case of a woman who sent some strange e-mails while she was asleep.

Sleepwalking can involve routine or unusual behaviors. Examples include making phone calls, walking outside or eating. But this is the first reported case of sleep e-mailing.

The New York Times reports that the woman was taking Ambien for her insomnia. The sleep e-mailing occurred after she decided on her own to increase her dose.

Like any other drug, sleep medications may cause some side effects. These side effects can include sleepwalking, sleep eating and other complex sleep behaviors. Some people also may experience memory problems.

The AASM Tips for Taking Sleep Medications note that you should follow your doctor’s instructions when taking a sleeping pill. Never increase the dose on your own. You also should only take the sleeping pill for as many days or weeks as your doctor tells you.

The Times article also reports that a new feature from Google could help protect sleepwalkers from sending embarrassing e-mails. It’s called Mail Goggles.

When enabled, it stops you from sending late-night e-mails on weekends. Before a message is sent, you have to solve a few math problems. The intent is to force you to stop and consider if you really want to send the message.

The math problems are fairly simple. But for a sleepwalker, it might be enough to prevent you from sending a strange e-mail to a co-worker or friend.

Update 03/02/09: The article appears in the February 2009 issue (volume 10, issue 2) of Sleep Medicine.