The bed is a very anxious place for 22 percent of Americans. Why? Performance issues. The nightly dance of tossing and turning to fall and stay asleep leads many to try either prescription or over-the-counter sleeping pills: Hypnotics and sedatives accounted for 63 million prescriptions filled in 2011, according to IMS Health. However, doing the mambo with the synthetic Sandman could come with serious health and safety risks.
Before filling your dance card...
Once you discussed your sleep problem with your physician and ruled out common non-prescription sleep remedies such as a sleep schedule; avoiding caffeine, tobacco, or other stimulants eight hours before sleep; not napping after 3 p.m.; and cognitive-behavioral therapy--a form of psychotherapy, you may decide that a prescription sleep aid might be your solution. Just know this: It's not clear whether sleep aids actually work. A 2012 analysis by Consumer Reports Best Buy Drugs found prescription sleep aids "might only be slightly more effective than a placebo."
What's more: these quick fixes may put your health in jeopardy. A study published in the British Medical Journal last year found adults who take prescription sleep aids are more likely to develop cancer, and far more likely to die prematurely, than those who take no sleep aids. And the risk increases even at low doses and low usage frequencies.
Case in point is the active ingredient zolpidem, which is found in Ambien, Ambien CR, Intermezzo, Stilnox and Sublinox. Zolpidem remains in the blood the morning after taking it, and it takes women longer to flush it out of their system than men. Because of this side effect, the FDA is particularly concerned about its role in traffic accidents: approximately 700 reports of zolpidem use and impaired driving ability and/or traffic accidents have been logged by the FDA's Adverse Event Reporting System.
As a result, the FDA recently issued new guidelines and dosage recommendations for sleep aids containing zolpidem. For women, dosing should be cut in half, from 10 mg to 5 mg for products containing the regular form of zolpidem (Ambien, Edluar, Zolpimist) and from 12.5 mg to 6.25 mg for zolpidem extended-release products (Ambien CR). Men should also consider taking the lower dose. If you are already on one of these medications, discuss the new guidelines with your doctor.
And what about the weird side effects of sleep-snacking or sleep-driving? The first could cause you to put on weight, the latter could kill you. Mr. Sandman doesn't look so sexy now, does he?
Partnering up with an OTC
Many health experts say sleep aids should only be used as a last resort. Though not habit forming, like prescription sleep aids can be, the FDA has only approved OTC sleep aids for use up to two weeks. "Over-the-counter antihistamine or antihistamine/analgesic type drugs (OTC "sleep aids") as well as herbal and nutritional substances (e.g., valerian and melatonin) are not recommended in the treatment of chronic insomnia due to the relative lack of efficacy and safety data," according to a 2008 special report published in the Journal of Clinical Sleep Medicine.
Whether you decide to opt for a prescription or an over-the-counter sleep remedy, make sure you partner up with your health professional as he or she can determine any possible interactions you'll want to stay away from, help you chose the best option for you and get to the root cause of your insomnia--which tends to be a symptom of something else-- and end your performance anxiety for good.