Q: If you take sleeping pills, are there safer substitutes for the ones that are subject to the new FDA boxed warnings?
A: The FDA is requiring the new stronger warning on certain insomnia medications that have been linked with risky complex sleep behaviors — such as sleep walking and driving while asleep — that have resulted in dozens of injuries and deaths.
The new warning requirements apply to eszopiclone, brand name Lunesta; zaleplon, brand name Sonata; and zolpidem, sold under the names Ambien, Ambien CR. Edluar, Intermezzo and Zolpimist.
These medications are in a class of drugs known as sedative-hypnotic, according to Dr. ISMAIL BOBAT, OSF HealthCare's medical director of the sleep lab, critical care and pulmonary services in Danville.
None of the three subject to the new warning labels cause a physical dependence, so they can be discontinued, Bobat said, though it's best to plan an alternative with a doctor to avoid rebound insomnia, he said.
Bobat said he agrees with the need for a stronger warning based on 66 reported cases of sleep behaviors resulting in injuries or deaths that have been linked to the drugs.
His advice for people seeking alternatives is to start by identifying the underlying cause of sleeplessness and trying to address that before turning to insomnia medicines.
He also advises patients to make sure they're practicing good sleep hygiene. That includes avoiding certain foods at night, cutting off caffeine and other stimulants before bedtime, getting enough exercise, having adequate exposure to sunlight during the daytime and darkness at night and establishing a relaxing bedtime routine.
If those things don't work, cognitive behavioral therapy will help some patients, Bobat said.
Before taking any medication, discuss the risks and benefits with your doctor, he advised. That should include discussing any history of your own or family members' complex sleep behaviors, he said. And anyone who's taken the insomnia drugs and experienced sleep walking and other risky behaviors while sleeping should stop these medications, he said.
Bobat also doesn't advise taking antihistamines as a sleep aid or over-the-counter sleep medicines.
Antihistamines may cause drowsiness, but they can also cause some unwanted results — such as a drying/dehydrating effect and elevated blood pressure, he said.
Of the over-the-counter sleep aids, melatonin may be one of the safest, Bobat said. But keep in mind commercially-produced melatonin is a supplement that doesn't fall under FDA regulation — so people buying it can't be certain about what they're getting, he said.