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To Sleep, Perchance to Sleep Soundly

Is the new generation of sleeping pills the answer for insomnia?

By Gina Shaw
WebMD Feature

Reviewed By Charlotte Grayson

Insomnia has been around as long as sleep has. Some even believe that William Shakespeare was an insomniac, writing as vividly as he did about sleeplessness, tossing and turning, and sleepwalking in plays like Hamlet and Macbeth. Today, old Will has millions of fellow sufferers: in a 2002 survey, the National Sleep Foundation found that 58% of adults have trouble sleeping at least a few nights a week.

One option today's insomniacs have that Shakespeare didn't, of course, is the sleeping pill. These drugs have a checkered past -- those who remember the deaths of Marilyn Monroe and Judy Garland from overdoses of sleeping pills may instantly reject the thought of taking a pill to get to sleep.

But over the past 10 years, a new generation of sleep medications has been developed, offering the promise of a good night's sleep without the perils of next-day hangovers or long-term addiction. They're called non-benzodiazepine hypnotics, but you probably know them as Sonata, Ambien, or Lunesta. Currently, they're considered the first-line medical treatment for insomnia.

A Good Night's Sleep, Without the Hangover

The older classes of sleep medications, particularly the benzodiazepines -- think Valium and Xanax -- do more than just help you sleep. They affect how you sleep, altering your actual "sleep architecture," says Donna Arand, PhD, clinical director of the Kettering Sleep Disorders Center in Kettering, Ohio.

"They tend to decrease the amount of time spent in certain stages of sleep, particularly stages three and four (the deepest, most restful stages of sleep)," says Arand, who serves on the boards of the American Academy of Sleep Medicine and the American Insomnia Association. "People also complained of hangover effects from these medications." That's because they tend to have a longer "half-life," which is the length of time the drug stays in your body.

Non-benzodiazepine hypnotics like Ambien, Sonata, and Lunesta, however, share several advantages over previous generations of sleep drugs:

  • They have a relatively short half-life, so you won't wake up groggy the next day. "There are minimal reports of 'hangover' effects with these new drugs," says Arand.
  • They have little, if any, effect on sleep staging, allowing you the REM sleep you need. "You spend pretty close to the same amount of time in each stage of sleep as you would without the drugs," she says.
  • They are less likely than other sleeping pills to cause addiction, withdrawal symptoms, or a buildup of tolerance (when you require more and more drug to have the same effect).

Why? The newer medications act only on specific receptors in your brain that are focused on sleep, while older groups of drugs have a more generalized effect on multiple brain receptors. "These new drugs are among the safest medications in medicine," says Thomas Roth, MD, Director of the Sleep Disorders and Research Center at Henry Ford Health System in Detroit.

But they are not right for everyone. "If you have insomnia due to sleep-related breathing disorders [sleep apnea] or restless legs syndrome, for example, these drugs won't address your underlying problem," says Roth. Pregnant women, of course, shouldn't take these medications. And if you're "on call," frequently getting up in the middle of the night for work or for a child, they might not work for you.

Here, briefly, are the pros and cons of the new sleep medicines, as well as of the older medicines commonly used to treat insomnia:

Sonata: Of all the new sleeping pills, Sonata has shortest half-life, which is the amount of time it takes for the drug to be eliminated from your body. Its half-life is just one hour. That means you can try to fall asleep on your own. Then, if you're still staring at the clock at 2 a.m., you can take it without feeling drowsy in the morning.

Ambien: The most commonly prescribed sleeping pill, Ambien has a medium half-life. It's less than two-and-a-half hours. This means that Ambien is great for helping you get to sleep but, like Sonata, could be less helpful if you tend to wake up a lot in the middle of the night.

Lunesta: Of all the new sleeping pills approved so far, Lunesta has the longest half-life -- about six hours. This means you may feel groggy in the morning if you take it in the middle of the night, or at a time when you can't get a full night's sleep. On the other hand, this pill could help you if you tend to wake up in the middle of the night a lot. Lunesta is the first sleeping pill approved by the FDA for long-term use to treat chronic insomnia. But it won't be alone for long: another sleep aid designed for long-term use, indiplon, is expected to launch later this year.