Sleeping Pill Safety: 10 Dos and Don'ts

Follow these guidelines if you take an over-the-counter or prescription sleep medicine.

From the WebMD Archives

It's 3 a.m. and you're staring at the green glow of your digital clock, wondering if you'll get any shut-eye before the alarm blasts in a few short hours. After several sleepless nights, you're feeling cranky and lethargic. Is it safe to start taking a sleep medication?

Many people turn to sleep aids because insomnia and sleep shortage have become commonplace in this country, leading to potentially serious consequences. In a 2008 National Sleep Foundation poll, 29% of respondents -- nearly one-third -- reported falling asleep or feeling very sleepy at work within the past month. And 36% reported that within the past year, they fell asleep while driving or nodded off at the wheel. Going without enough sleep can also lead to headaches and contribute to depression.

In light of all that lost sleep, it's no wonder that millions of people turn to over-the-counter and prescription sleep medicines. If you're one of them, here's what you need to know to use those products safely.

Types of Sleep Medicines

Some people seek out over-the-counter sleep aids, such as melatonin, valerian, and products with antihistamines, including Benadryl, Sominex, and Tylenol PM. Others take prescribed antidepressants with sedating effects, even though these drugs aren't FDA-approved for treating insomnia.

Other people use prescription sleep medications approved specifically for insomnia. In the past, doctors frequently prescribed an older class of drugs called benzodiazepines, including Dalmane, Halcion, and Restoril. But benzodiazepines carry serious risks of physical addiction and overdose.

Nowadays, doctors are more likely to prescribe a newer class of sleep drugs called "gamma-aminobutyric acid (or GABA) medications," which appear to be less risky for addiction, although a small potential exists. Common brands include Lunesta, Ambien, and Sonata.

These GABA drugs help patients fall asleep, stay asleep, or both. They're an improvement over benzodiazepines, experts tell WebMD.

"In general, the medications that are approved for the treatment of insomnia by the FDA are quite safe and effective medications with relatively low side effect profiles," says Michael J. Sateia, MD, professor of psychiatry and chief of the section of sleep medicine at Dartmouth Medical School. "Most folks tolerate these medications well."

Rozerem, a melatonin receptor agonist, is another type of prescription medication that helps people fall asleep more quickly.

All sleep aids or medications must be used carefully. For instance, you should never combine them with alcohol. Prescription sleeping pills can also trigger disturbed sleep behaviors, such as sleep-eating and sleep-driving, especially if used improperly.

Here are 10 dos and don'ts for taking sleep medicines.

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1. Do talk to your doctor about your sleep problems.

If you have insomnia, see your physician first to get a proper diagnosis. Your doctor or a sleep specialist may be able to pinpoint a cause, for example, a sleep disorder or a medical problem, such as depression. Treating insomnia without a thorough exam can mask an underlying problem that requires care.

Be sure to tell your doctor about all health conditions and all drugs that you're using, including prescription, over-the-counter, and complementary medicines. If your doctor prescribes sleeping pills, he or she needs to ensure that they won't interact with other drugs or worsen any medical problems.

Before you use any sleep aids or drugs, read all instructions and package inserts carefully to understand safe use and to learn about possible side effects.

2. Do time your medications properly before bedtime and plan for a full night's sleep.

Make sure that you've scheduled enough time for a full night's sleep, typically seven to eight hours for most people. If you take a sleep drug and wake up after only a few hours, you may still feel groggy.

Timing is key, Sateia says. "If someone has a sleep onset problem, they probably [should] take these medications perhaps 20-30 minutes before bedtime." Once you've taken a sleeping pill, it's important to get into bed quickly, Sateia says, "probably no more than 10-15 minutes after ingesting the medication."

Most prescription sleep medicines reach maximum levels about 1 to 1 ½ hours after someone takes them, Sateia says.

3. Do stop waking activities after you've taken a sleeping pill.

Going to bed within a few minutes after taking a prescription sleeping pill will help prevent "complex sleep-related behaviors." According to the FDA, people on sleep drugs have eaten, made phone calls, had sex, and even driven while not fully awake -- and they have no memory of those acts.

As Sateia explains, people enter a "sleep-walking" phase while they're still awake, rather than entering from a sleeping state. That can produce some of the untoward effects, like eating disturbances or bizarre behavior, Sateia says.

It's easy for people to get sidetracked, Sateia says. "They take their sleep medication, and they may intend to get into bed, and then they say, 'Oh, I forgot to do this, I need to do that,' and they're up and 45 minutes later, they're trying to eat the plant because their brain has gone home for the day."

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4. Do report side effects to your doctor.

If you struggle with feeling sleepy, groggy, or dizzy during the day, ask your doctor if you need to change your dosage or taper off a sleep drug. Tell your physician about other problems, too. Prescription sleeping pills can cause side effects, including dizziness, prolonged drowsiness, headache, bloating, nausea, abdominal pain, constipation, and rarely, severe allergic reactions or facial swelling.

Over-the-counter sleep aids may prompt side effects, too. For example, diphenhydramine, a antihistamine commonly used in drug store sleep aids, can cause dizziness, memory problems, and prolonged drowsiness that lingers into the following day.

Who's at greater risk for side effects? Older patients, as well as people with medical conditions or people who take other drugs, says Margaret H. Tomecki, Pharm.D., FAPhA, senior manager of practice development and research at the American Pharmacists Association. "These individuals should talk with their pharmacist or doctor prior to trying any products for insomnia," Tomecki says.

5. If you have persistent insomnia, do improve your sleep with lifestyle changes or cognitive-behavioral therapy.

Sleep medications can work wonders for short-term insomnia that stems from stress, jet lag, illness, or other temporary problems.

In contrast, some patients use the drugs for chronic insomnia that can last for months or even years. These patients may benefit from cognitive behavioral therapy, Sateia says. With such treatment, a trained sleep therapist uses many techniques, including ones to help people control negative thoughts and worries that keep them awake.

Lifestyle changes may also improve sleep for people with insomnia. Some sample measures: establishing a regular sleep pattern, avoiding daytime napping, and shunning caffeine, alcohol, or nicotine for at least 4-6 hours before sleeping, Tomecki says.

6. Don't mix over-the-counter (OTC) or prescription sleep medicines with alcohol or other drugs that depress the nervous system.

Mixing drugs could cause adverse interactions. Taking sleep aids or sleep drugs with alcohol, even a small amount, increases the sedative effect and may cause you to feel confused, dizzy, or faint.

"Alcohol itself disrupts the sleep cycle," Tomecki says.

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7. Don't drive a car or operate machinery after taking any kind of sleep product.

You won't be alert, so these activities can become dangerous.

8. Don't increase the dosage that your doctor prescribed.

With the older benzodiazepines, doctors worried about patients increasing dosages on their own as they became more tolerant, which could lead to physical addiction.

"There is no question that if one takes substantial quantities of benzodiazepines over periods of time and escalates dosage and stops those medications, there's a real possibility of serious withdrawal," Sateia says. "Those individuals are addicted and benzodiazepine withdrawal can be quite serious; it can be life-threatening."

That's much less of a problem with the newer GABA prescription drugs. "They've demonstrated a reduced abuse potential," Tomecki says.

Sateia agrees. "Individuals with chronic primary insomnia are able to take these medications in apparently quite safe fashion with continued effectiveness, without dosage escalation or evidence of significant withdrawal symptoms when stopped," he says.

But taking a higher dose than prescribed boosts the risk of complex sleep-related behavior, Sateia says.

9. Don't hide it from your doctor if you're taking other sleep products, including over-the-counter ones.

Sateia frequently sees patients combining prescription and over-the-counter sleep products. "The biggest problem is that really, their doctors don't know what they're taking, which introduces further potential for various 'drug-drug' interactions," he says.

Using more than one sleep product is also a red flag, Sateia says. "It usually represents a desperate attempt to find the right medication or combination of medications that are going to solve the problem. It's almost always a counter-productive strategy."

Instead, "People need to work closely with their doctors to identify an appropriate medication," Sateia says. For example, people may be losing sleep because they're struggling with pain or depression. They may need to treat these issues before they can sleep better.

10. Don't stop taking a sleep medication unless you consult your doctor first.

If you've been taking prescription sleep drugs for an extended period, don't stop abruptly, in order to avoid withdrawal symptoms such as anxiety, nausea, and muscle cramps.

Not everyone experiences withdrawal symptoms -- it depends, in part, on what type of drug you've been taking, how often, and for how long. But instead of taking matters into your own hands, ask your doctor whether you need to taper off the drug and how to do so.

That can be done in two ways, Sateia says. First, you can gradually reduce the frequency. If you take the drug nightly, you can pick one night of the week to skip it. When you've acclimated, then you can skip two nights and eventually wean off.

Or you can still take the drug nightly, but gradually reduce the dosage, Sateia says. But again, check with your doctor first.

WebMD Feature Reviewed by Louise Chang, MD on January 12, 2010

Sources

SOURCES:

Michael J. Sateia, MD, professor of psychiatry and chief of the section of sleep medicine, Dartmouth Medical School.

Margaret H. Tomecki, PharmD FAPhA, senior manager of practice development and research, American Pharmacists Association.

National Sleep Foundation: "Sleep in American Poll Summary of Findings."

FDA: "Side Effects of Sleep Drugs."

MayoClinic.com: "Prescription sleeping pills: What's right for you?"

MayoClinic.com: "OTC sleep aids and supplements: What's best and safe?"

Mayo Clinic: "Insomnia treatment: cognitive-behavioral therapy instead of sleeping pills"

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