The Sleep-Easy Pill

Last Editorial Review: 1/30/2005

Sonata treats insomnia without next-day grogginess.

WebMD Feature

For years Sandy Abrao has thrashed in her sheets. It's two in the morning, it's three, even four, but sleep just won't come.

"I'm up constantly, I just can't get to sleep," says Abrao, a 50-year-old office manager near San Francisco who must be at work by 8:30 a.m. "When you don't sleep, you're aggravated so much -- by things at work, by things at home."

New Drug

A new medicine on the market might give Abrao and millions like her some relief. Called Sonata, the drug is a sleeping pill with a short "half-life," or period of influence in the body: Its sedating effect only lasts one to three hours. Most sleeping pills make users sleepy for at least eight hours.

Sonata's short life span makes it beneficial for people who struggle to fall asleep but don't have trouble staying asleep, say sleep experts. It may also be a good option for someone who occasionally wakes up in the night and can't fall back to sleep. But because Sonata is short-lasting, it isn't appropriate for people who wake up repeatedly throughout the night and need help staying asleep. And some experts fear it will still be abused.

"With Sonata, you can take it in the middle of the night and not feel groggy in the morning," says psychologist Derek Loewy, a director at the Stanford Sleep Disorders Clinic in Palo Alto, Calif. "It's not so good for people with a strong sleep maintenance problem, people who wake up often in the night."

Research Indicates Safety

Sonata, whose pharmaceutical name is zaleplon, came on the market in mid-August. Its closest competitor is zolpidem (sold under the brand name Ambien) whose effects last four to six hours.

In a study published in the September 1999 issue of the British Journal of Clinical Pharmacology, people who took Sonata two and five hours before waking didn't experience noticeable hypnotic or drowsy effects, such as a hazy memory or delayed reaction time once they were up and about. The U.S. Federal Drug Administration has approved Sonata for use four hours or more before waking.

Besides being short-lasting, Sonata hasn't been linked to undesirable side effects, and doesn't cause withdrawal symptoms or a rebound of insomnia when someone stops taking it.

But experts warn that Sonata should only be used temporarily. "Our approach is no one should be on sleep medication for a long period of time," Loewy says. Many medications, including Sonata, haven't been studied for long-term use, he says.

And people using even non-addictive medicines can become psychologically hooked. "Patients lose the ability to fall asleep on their own. It becomes an automatic response: Take the pill, take the pill."

One Option

Instead of relying on medication alone, Loewy and other experts advise insomniacs to address the underlying causes of their problem. People with sleep problems should be examined by their doctors to see if they have any related health problems. Next they should make sure they practice good sleep hygiene. For example, they should not lounge in bed, drink lots of caffeine or alcohol before bedtime, or take naps. They should get plenty of exercise.

The next line of treatment is often behavioral therapy, in which psychotherapists work closely with insomniacs to teach better sleep habits and help them cope with stress and tension.

Perhaps the best way to view Sonata is as a useful tool in the chest of remedies, says Richard Gelula, the executive director of the Sleep Foundation. "We welcome the options for patients and for those prescribing for patients. Now they can tailor treatment more effectively."

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