When you just can’t sleep

Reservations about the safety of prescription sleeping pills have been around for a long time. But recent new research has raised fresh concerns about when they’re appropriate and who’s most at risk.

To summarize: A study by the U.S. Centers for Disease Control and Prevention and Johns Hopkins University found that psychiatric medications – a category that includes sedatives – account for thousands of emergency room visits in the U.S. each year. One of the key findings, which may have come as somewhat of a surprise to the public, was that zolpidem, or Ambien, was implicated in 90,000 emergency room visits annually for adverse drug reactions.

The majority of ER visits for drug reactions associated with sedatives and anti-anxiety medications were among adults in their 20s, 30s and 40s. But among older adults who were taking these medications and ended up in the ER, the consequences were often more severe and were more likely to result in hospitalization.

This could be an opportunity to address adverse drug events, or emergency room utilization, or prescription drug use, or medication use by older adults. But I’m not going there, at least this time.

If I ruled the world, we would have a long-overdue national conversation about sleep and insomnia.

We’d open with a discussion of the “sleep is for wimps” mindset. Where does this come from, and who do these people think they’re kidding?

We’d take a look at the science. What do we know about the human body’s need for sleep and the mechanisms of sleep? How many questions still lack good answers?

We’d involve the medical community. How often are patients queried about their sleep? Is there more than one option for helping them, or is the immediate response to hand out (or refuse) a prescription for a hypnotic or to assume the problem is related to stress or lifestyle?

Finally, we’d get real about insomnia. Although sleep difficulties can often be traced to how people live their lives, simply telling them to practice better “sleep hygiene”┬ámay not cut it for those whose insomnia is longstanding, complex and more challenging to treat.

Somewhere in the discussion we might talk about shift work and the impact it has on sleep and health. We could talk about sleep apnea and restless legs syndrome as specific causes of poor sleep, while at the same time recognizing that many people with insomnia don’t have either of these conditions.

We could probably talk about the punishing levels of daily stress experienced by many people and how it interferes with their sleep.

And yes, we’d have a serious discussion about where pills fit into this. We would acknowledge that sleep aids are sometimes prescribed to people who don’t really need them or whose safety might be compromised by taking them. But if we’re being fair, we’d also have to recognize that clamping down on sleeping pill prescriptions could consign many people to chronic, intractable insomnia – and as anyone with longstanding insomnia can attest, it’s a miserable and ultimately unhealthy place to be.

Who’s up for the conversation?

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