Should you worry?
If you’ve ever considered sleeping pills, you may have worried about how you’d feel the next day, whether you’d get hooked, and what other effects the medication might have on you. When used correctly, prescription sleep drugs are safe and effective, and can help you get through a patch of insomnia or fitful sleeping. In fact, doctors say they're more reliable than over-the-counter meds for any extended period of time.
Side effects can occur, however, especially if you’re not taking the best type of medication for you, at the right dosage. Here are a few problems you may experience, and what you can do to avoid them.
Many people worry that, should they decide to take sleeping pills, they'll feel tired, fuzzy-headed, or dizzy; experience headaches or nausea; or have trouble waking up the morning after. These side effects are possible, but avoidable, says Ralph Downey III, PhD, director of the Loma Linda University Sleep Disorders Center in Loma Linda, Calif. If your doctor has prescribed the correct dosage, and you take the pill according to your doctor’s instructions, the medication should work effectively without any morning hangover, Downey says. Older drugs such as benzodiazepines are more likely to cause morning drowsiness or dizziness, because they have longer half-livesmeaning the effects take longer to wear off.
Getting a good night's sleep may pose dangers for people with mild heartburn and the more than 40% of Americans with gastroesophageal reflux disease (GERD). A 2009 study found that people taking Ambien were less than half as likely to wake up during bouts of acid reflux, increasing their exposure to nighttime stomach acid. This backwash can cause damage to the esophagus that may not have occurred had the person awoken and swallowed, neutralizing the acid with saliva. This type of damage to the cells lining the throat may increase the risk for esophageal cancer. Read more about the connection between sleeping pills and heartburn here.
Dependence or addiction
Patients are often nervous about becoming addicted to or dependent upon sleeping pills. But studies show that the risk of sleeping pill abuse is decreasing as new medications are released. Researchers have found that Rozerem, a relatively new drug, may have the fewest side effects of all, and it seems to be non-habit-forming. However, addiction and dependence are still possible with other drugs, especially benzodiazepines.
Taking sleep medications long-term can mask the real cause of insomniasuch as poor sleep habits or too much stress. Patients often tell their doctors that they're dependent on medication, but it's possible they haven't addressed underlying issues affecting their sleep, and that they don't really need the pills.
One of the most important things to know about sleep medication is how and when to stop taking it. Abruptly stopping the use of a sleep aid can cause rebound insomnia, meaning you may experience the same or even worse symptoms of your sleep disorder without medication. “To be safe, I assume that the effect may occur” in all patients, Downey says. That’s why he tells patients to never stop using a sleeping pill without first consulting a doctor. Many sleep experts will wean their patients off sleep medications by prescribing lower doses or different medications, until they’re ready to sleep on their own.
The makers of Lunesta (eszopiclone) alert patients to a common side effect: a bitter or chemical taste in the mouth. In a 2004 study of 300 adults with insomnia, 34% of people taking 3 milligrams of Lunesta experienced an unpleasant taste, and 17% noticed the taste from a 2-milligram dosage. Other patients may experience dry mouth.
Sexual side effects
Although Downey hasn’t observed any significant problems at the doses at which Rozerem is prescribed, he says it is possible for this medication to interact with hormones. "Rozerem is a melatonin agonist, so it increases the level of melatonin by about 16 times what it would normally be in the brain,” says Downey. This increase in melatonin will put you to sleep, but could also alter testosterone levels. You could experience changes in your sex drive as well as your menstrual cycle.
Sleepwalking, eating, and driving
Patients taking sleep medication have reported such automatic behaviors as walking, eating, and even driving in their sleep—and not remembering it in the morning. “The most problematic thing is not that they just eat. I have patients that will get up and cook and leave the gas on overnight,” says Downey. Zolpidem (Ambien) in particular has been linked to sleep eating, although this apparent trend may be a function of the large number of people taking zolpidem, rather than a specific quality of the drug.
Downey stresses that automatic behavior is relatively rare, however. “We’ve only had one person here do that, and we evaluate over 1,000 people a year.” Nevertheless, the Food and Drug Administration considered the risk serious enough to request that all sedative-hypnotic drug products carry a warning about the potential for sleepwalking and similar behaviors.
If you suffer from severe restless legs syndrome, you may be prescribed a dopamine agonist such as ropinirole or pramipexole. Side effects include nausea and dizziness, but these medications have also been linked to compulsive gambling, eating, and sexual habits. A 2005 Mayo Clinic study found 11 cases of patients who had developed gambling habits while taking dopamine agonists for Parkinson's disease. In 2007, three RLS patients (including a woman who lost more than $140,000) were cited in another report.
Dopamine agonists target receptors in the brain associated with motivation and reward; researchers suggest that anyone taking these drugs be screened for compulsive behaviors and monitored carefully for warning signs.
Another consequence of taking drugs for restless legs syndrome is that after an extended period of time, they may lose effectiveness. In fact, symptoms can return more severely, more frequently, and earlier in the night than before medication was started—a process called augmentation. Taking higher doses won't usually help, and patients may need to switch to a different class of drug or take a few weeks off from medication altogether.
Cost of medications
Getting a good night’s sleep can cost a pretty penny. It’s not exactly a side effect, but the high price of sleeping pills is definitely a downside. Insurance typically picks up part of the tab for prescription sleep drugs, but for medications that are only approved for short-term use, your provider may decideeven before your doctor doeswhen you’ve had enough. After a few months, patients may need to switch to cheaper generic medications or turn to long-term behavioral treatments.
Consider other treatments
Sleep experts agree that behavior therapy or cognitive behavioral therapy (CBT) are still the most effective treatments for long-term sleep problems. In therapy sessions, you’ll learn habits and behaviors that will help your body get used to sleeping again—at the right time and for the right amount of time. And unlike a pill, you can recall and practice those routines every night, for free.
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