A Doctor’s Advice About Insomnia

A Doctor’s Advice About Insomnia is written bWilliam C. Thornbury, Jr., M.D.

Insomnia, difficulty falling or staying asleep, affects an estimated ten percent to fifteen percent of the population.  For two decades, millions of Americans have taken Ambien (zolpidem) to help them sleep at night. Sleeping pills have boomed in popularity with the increasingly frantic pace of modern American life. According to IMS, a health care information and technology company, about 60 million prescriptions were dispensed in 2011, up about 20 percent since 2006. About 40 million were for products containing zolpidem.  Sleeping pill use is especially common among women.  While these medications can be used safely and effectively in the appropriate situation, there are risks that should be considered.

For women, in particular, the lowest effective dose should be used with the starting dose at 5 mg.  The Food and Drug Administration recognized in January 2013 that the medication is cleared from the body more slowly in women than in men after multiple reports of car accidents the following morning after Ambien had been used.  An estimated 10 percent to 15 percent of women will have a level of zolpidem in their blood that could impair driving eight hours after taking the pill, while only about 3 percent of men do.

Other risks of Ambien use include dizziness, grogginess, worsening of depression, and performing complex behaviors such as driving, walking, or eating in one’s sleep have also been reported without any recollection of the events.   Of note, in a 2012 study comparing 10,000 users of sleeping pills like zolpidem to nonusers, pill takers were up to 35 percent more likely to develop some type of cancer, including lymphoma and lung cancer, and they were 4.56 times more likely to die of any cause. Though the reasons are still unclear, “the risk of death was substantial even in people taking just 18 pills a year—but it increased the more they took,” said study author Dr. Daniel Kripke, of the Scripps Clinic Viterbi Family Sleep Center in San Diego.  It is important to note that this is one study and much more work needs to be done to sort out the relationship between Ambien use and increased risk of death, if any.

Sleep medications can be useful in the short term — but the best approach is to address whatever’s causing your sleep problems in the first place. If you still have trouble sleeping, other therapies include learning new sleep habits (such as keeping your bedtime and wake time consistent from day to day), getting counseling for anxiety or other psychological concerns, and using stress-reduction techniques.  Ask your family physician.  He or she may recommend an evaluation at a sleep center to determine the cause of and best treatment for your insomnia.

William C. Thornbury, Jr., M.D.

Dr. Thornbury is a leading practicing clinician in Kentucky. He is a summa cum laude graduate of the University of Louisville School of Medicine, and studied with Harvard Medical School at The Cambridge Hospital. His 22 years of experience include five as a practicing pharmacist, two in general surgery, and fifteen years of specialty certification in primary care medicine. Dr. Thornbury is considered an International thought leader in mobile health with multiple publications and invited lectures in the United States and Europe. He is founder of Me-Visit Technologies, a company dedicated to helping doctors make online house calls with their patients using a smartphone, tablet, or computer.

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