Sleep Drugs: None Stands Out as Best

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Sleep Drugs: None Stands Out as Best

Analysis Shows New Generation of Sleep Drugs Equally Effective

By Salynn Boyles

WebMD Medical News

Reviewed By Louise Chang, MD

on Friday, December 09, 2005

Dec. 9, 2005 - Those heavily advertised prescription sleep drugs do

work, but no single drug stands out as clearly superior to the

others, a new review of the research shows.

Researchers analyzed 141 published studies of the new generation of

sleep aides, including the prescription drugs Sonata, Ambien, and

Lunesta.

They found that all three drugs, as well as a chemically similar

sleep drug sold in Canada, worked better than a placebo for treating

insomnia symptoms and helping people get a good night's sleep.

Comparing Drugs

But there was little evidence that any one drug worked better than

another for specific types of insomnia because only a few trials

compared the medications head to head. Not much information was

available about the safety of long-term use.

" We found no studies comparing the different drugs in patients with

different insomnia complaints, so we do not know for sure that one

drug would work better in one patient over another, " says researcher

Carson, MPH. Carson is a senior research associate at the

Oregon Evidence-Based Practice Center.

Sleep experts who spoke to WebMD said that even though the clinical

trials have not established clear differences between the drugs,

clinical practice has.

Ambien and Sonata are more shorter acting than Lunesta or a newly

available, extended release form of Ambien, known as Ambien CR, says

J. Stepanski, PhD.

Shorter-Acting vs. Longer-Acting Drugs

Shorter-Acting vs. Longer-Acting Drugs

The shorter-acting drugs may be the best choice for people who have

trouble falling asleep but have no trouble staying asleep, he says.

Stepanski directs the Sleep Disorders Service and Research Center at

Chicago's Rush University Medical Center. He is also president of the

American Sleep Medicine Foundation.

He says the longer-acting drugs tend to work better for people who

wake frequently during the night and can't get back to sleep.

The new-generation sleep aides more directly target the area of the

brain that controls sleep than earlier drugs. As a result they are

less addictive and less likely to cause daytime grogginess.

But the Oregon researchers say the long-term safety and side effects

of the drugs have never been compared. They note that there is

evidence that patients can become addicted to them.

Drug Misuse?

Neubauer, MD, says clinical experience over more than a decade

has proven that the risk of abuse and addiction is small.

Neubauer is associate director of the s Hopkins Sleep Disorders

Center. He is also author of the book Understanding Sleeplessness:

Perspectives on Insomnia.

" For the most part the people who misuse these medications are the

ones who misuse other things as well, " he says.

Carson tells WebMD that comparative studies and studies that track

the long-term effectiveness and safety of the drugs are still needed.

Although most of the drugs are not approved for long-term use, many

patients take them for extended periods.

She adds that there is at least some evidence that the drugs can

increase the risk of bone fractures in elderly people who take them.

Older people tend to have the most sleep problems and are the most

frequent users of prescription sleeping pills.

" We need longer-term, controlled studies to look at adverse events, "

she says.

SOURCES: Carson, MPH, senior research associate, Oregon

Evidence-based Practice Center. Neubauer, MD, associate

director, s Hopkins Sleep Disorders Center; author, Understanding

Sleeplessness: Perspectives on Insomnia. J. Stepanski, PhD,

director, Sleep Disorders Service and Research Center, Chicago's Rush

University Medical Center; president, American Sleep Medicine

Foundation. Medco Health Solutions report: " Sleep Deprivation Driving

Drug Use and Costs, " Oct. 17, 2005.

http://www.webmd.com/content/Article/116/112074.htm