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Experts Weigh in on Sleeping Pill Danger
In 2010, as many as 1 in 10 Americans used one of the sleeping pills in the Kripke study. Can they really be that deadly?
Experts consulted by WebMD note that the Kripke study certainly raises a red flag. But they all note that this study -- a look-back study based on patients for whom there is incomplete information -- is not proof that sleeping pills kill.
This "very provocative and interesting study raises a lot of questions," says Nancy Collop, MD, president of the American Academy of Sleep Medicine and director of the Sleep Center at Emory University School of Medicine.
"You cannot assume, just because you find this kind of association, that hypnotics are killing people," Collop tells WebMD. "People who go on sleeping pills are a sicker population. I know they tried to control for that, but these people simply are not as healthy."
Bryan Bruno, MD, chair of psychiatry at New York's Lenox Hill Hospital, notes that the actual number of people who died in the study is small.
"This does not establish any direct cause-and-effect relationship between hypnotic use and death," Bruno tells WebMD. "But it does remind us that these drugs have risks, and even mortality, associated with them."
Michael Yurcheshen, MD, head of the sleep fellowship program and assistant professor of neurology at the University of Rochester, N.Y., notes that much can be missed in a study that looks back at medical records rather than at the patients themselves.
"It is implausible to think that so many of these medications, spread across several different drug classes, could have the same biological effects," Yurcheshen tells WebMD.
Sleeping Pills: Right Ways and Wrong Ways to Use Them
Collop, Bruno, and Yurcheshen praise Kripke for raising the issue of sleeping pill harm.
"One part of the Kripke study I really did like is when they point out that part of the problem with hypnotics is they are really best for people with acute, short episodes of insomnia," Yurcheshen says. "Very few insomnia drugs are approved for long-term daily use. And so it is fair to say that the long-term safety of these drugs has never been explored for use in that way."
Collop says she personally is "torn whether hypnotics are good or bad." She notes that it can be harmful to be dependent on hypnotic sleeping pills for a long period of time. They can help a person who is having a hard time falling asleep for some specific reason.
"These sleeping pills are mostly for short-term use," she says. "So the ideal patient would be someone with a very high stress level for some reason, such as the recent loss of loved one or a divorce, or for a traveler adjusting to a new time zone. This should be for a limited time period and only as needed, not on a nightly basis. In such situations these drugs are appropriate and effective."
Bruno notes that hypnotic sleeping pills affect the quality of sleep. When used too often, he says, "people don't feel as restored after sleeping with them."
He also points out that many hypnotic sleeping pills are habit forming. "For those at risk of addiction, or with other addictions, they can be dangerous," he says. "And most of these drugs increase the effects of alcohol."