Q:
Can sleeping pills give me nightmares?
A:
Not usually, Arand says, "but some sleep meds can suppress dream recall." When you stop taking them, the dreams (and possibly nightmares) may return. The mechanism isn’t fully understood, but once there’s a withdrawal—even just when the dosage wears off during the night—vivid dreams can occur.
Q:
Can I safely take sleeping pills for several months?
A:
There are no known long-term health risks with most sleep aids, but some are more addictive than others. "The newer medications like Ambien CR, Sonata, Rozerem, and Lunesta have been approved by the Food and Drug Administration without a limit on how long they can be prescribed," Arand says. "They have a small addiction potential, and some have been shown to be effective up to one year." The older sleeping pills with secobarbital (Seconal) and pentobarbital (Nembutal) pose a much higher risk of addiction.
Tolerance is a common problem with all sleeping pills: After taking them for a while, you need more than the usual dose to help you sleep, which may lead you to think you’re addicted. If the drug doesn’t seem to be working as well as it used to or if you’re taking more than your prescribed dosage, tell your doctor; she can change or adjust your medication.
Q:
I’ve been taking sleeping pills for several months. What’s the best way to wean myself off?
A:
With your doctor’s help, gradually step down your meds. Generally, you want to reduce drugs by one clinical dose per week: If you’re taking 10 milligrams of traditional Ambien a night, start taking 5 mg a night for a week, Arand recommends. Next, cut that pill in half and take that amount for a week. Then, stop taking the drug altogether. Medications in pill (not capsule) form that aren’t time-release versions are OK to split. (You can split Ambien, for instance, but not Ambien CR.)
Q:
I’ve heard of rebound insomnia. Is it really harder to fall asleep and stay asleep without pills if I’ve taken them a few times?
A:
You might have some trouble, Dr. Krieger says, though it’s less likely with the newer pills—these include Rozerem, Sonata, and Lunesta. "Give it a few days to adjust after you stop taking the medication," Arand explains. If you still can’t sleep, talk to your physician. Rebound insomnia is one of the reasons some experts recommend CBT over sleep medications.
Q:
If I don’t want to use sleeping pills, are natural remedies worth trying?
A:
Yes, but don’t expect miracles. Melatonin, a sleep hormone your body makes naturally, and the herb valerian may be helpful (both are available at drugstores), but some experts feel there’s a lack of research to back up the effectiveness of these supplements. Plus, they’re not regulated like drugs, so you don’t always know what you’re getting.
That said, if you want to try melatonin, take 0.2 to 1 mg about four hours before bedtime: "It’s safe to take every day," Dr. Krieger says. "As we age, our bodies secrete less of it, so taking a supplement can be helpful." Melatonin may be particularly beneficial when you travel several time zones to the east (like Europe) and have trouble falling asleep. As for valerian, there’s no recommended dosage, and it’s not clear how the herb works. Before using any supplements, check with your doctor; combining them with other medications—sleeping pills or otherwise—can be risky.
This content was first published in Health magazine, September 2008
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