Content provided by the Faculty of the Harvard Medical School

By the way, doctor: Are sleeping pills addictive?

By the way, doctor

Are sleeping pills addictive?

Q. My primary care doctor tells me that all sleeping pills on the market are addictive. Does this mean you develop a craving for them or simply that you become unable to sleep without taking them? I’m 92 and realize that easy sleep and age aren’t compatible. Please advise.

A. I’d call sleeping pills variably addictive. People don’t crave them the way that, say, a heroin addict craves heroin. But many people do become psychologically dependent — they believe they can’t sleep without them. And it’s not just in their heads, either. If people take sleeping pills for a while and then stop, they often experience a rebound effect, becoming more wakeful and restless and agitated at bedtime than ever before.

But as a geriatrician, I don’t worry as much about dependence and rebound as I do side effects. Sleeping pills — especially the longer-acting benzodiazepines like diazepam (Valium) and flurazepam (Dalmane) — linger in the body, so people feel drowsy and “out of it” during the day. Drowsiness, particularly among older people, causes falls and accidents. Shorter-acting sleeping pills were developed to avoid this problem, but in my experience, some people develop a tolerance for them, so they wind up taking more pills to get the same sleep-inducing effect and daytime sleepiness still is a problem.

Late in 2004, the FDA approved a new sleeping pill, eszopiclone (Lunesta). The approval was based on clinical trials that lasted six months, which is longer than usual. Even the longer studies don’t tell us whether it’ll be safe to take this new drug for years.

Besides, I think doctors are sometimes too quick to prescribe a sleeping pill. They might arrive at a better solution if they spent more time with patients. Often it takes me a couple of visits to sort out a sleeping problem. Sometimes sleeplessness is caused by another, treatable condition. And in many cases, the solution lies in the area of “sleep hygiene,” or sleep habits.

Some points that I raise in discussing sleep hygiene include the importance of having regular times for going to bed and waking up; cutting back on daytime naps; and avoiding caffeine, alcohol, and heavy or spicy foods for several hours before bedtime. I also suggest that patients get some exercise, but it should be earlier in the day. Vigorous exercise in the evening tends to wake people up, not make them sleepy.

— Kenneth Minaker, M.D. Massachusetts General Hospital Harvard Health Letter Editorial Board

Last updated:	August 21, 2006