Sleep Medications may be Overprescribed

Behavioral therapy less risky than medication for insomnia

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Although nearly one in four Americans suffers from insomnia, many remedies commonly used for a bad night's sleep have potentially unsafe side effects. 

Over-the-counter sleep aids and physician-prescribed drugs such as antihistamines, antidepressants, sedatives and antipsychotics can have significant side effects and risks, and may be widely overused according to some experts.

"Consult your doctor about the side effects of insomnia remedies."

The effects of insomnia are hugely problematic, beyond the negative personal consequences that people suffer when they have trouble sleeping. The effects also take a huge toll on our economy and workforce. Researchers at Harvard Medical School recently found that more than 252 million days of lost work performance were associated with insomnia, equating to a total national economic cost of $63.2 billion per year.

Nancy Collop, MD, president of the American Academy of Sleep Medicine, says that many of the sleep aid methods commonly used can pose significant risks. The most common OTC treatments are antihistamines, which have no real evidence of efficacy and can be dangerous for vulnerable populations like the elderly. Many people also self-medicate with alcohol, which actually has an adverse effect on quality sleep.

On the prescription side, doctors often prescribe antidepressants such as trazodone for sleep inducement. Collop says that such off-label use has potential adverse effects and raises concerns about the risk-benefit ratio. Sedatives and antipsychotic drugs, which are also often prescribed, can have major side effects and are not recommended for chronic use.

The key to treating insomnia lies in evaluating the patient's sleep environment, habits, stress and other health conditions, taking a behavioral approach to treatment before incorporating a pharmacologic approach, if necessary. Collop says, "Prescribing a pill may be the easiest thing to do in a busy practice, but this response is not a good long-term solution." She recommends a priority for behavioral therapies such as relaxation training, stimulus control and sleep restriction, possibly in conjunction with cognitive therapy to reduce anxiety.

"Physicians should educate patients about the prescribed sleep medicine, including the indications for use, dosage and side effects," Collop says. "I always suggest that patients take the first dose on a night when they don't have to go anywhere the next morning; it is also critical for patients to be aware that a sleep medication should never be combined with alcohol."

Collop's recommendations were published on the American Medical Association website in November, 2011.

Reviewed by: 
Review Date: 
November 9, 2011
Last Updated:
November 11, 2011