When you suffer from insomnia, a sleeping pill that delivers a good night’s rest can seem like a gift from heaven. But they’re not without sometimes strange side effects and even risks. We got tips on sleeping pill safety from Dr. Sam Fleishman, president and spokesperson for the American Academy of Sleep Medicine.
Do check in with your doctor if you currently take a prescription sleep aid. The U.S. Food and Drug Administration recently revised their dosage recommendations for commonly prescribed sleeping pills, including Ambien. The change is based on some safety studies that found the drugs tended to linger in patients’ systems—particularly women’s—for longer than 8 hours. With that amount of the drug still in their system in the morning, says Fleishman, “people could wake up the next day and have impairment, it could affect driving, and other complex tasks.”
The new recommendations call for cutting dosages in half—starting patients at 2.5 mg instead of 5 mg, and lowering the upper limit from 10 mg to 5 mg—but even if your dose is already fairly low, you should still consult your doctor to discuss lowering it further.
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Don’t pop a sleeping pill until you’re actually in bed. Over-the-counter sleep aids can be slow to act, so if you’re used to taking those, you may think you can take a prescription pill while you’re still watching TV. But so-called “hypnotics” like Ambien and Lunesta take effect within about 15 minutes. Some patients have reported strange behavior like sleepwalking, sleep eating or otherwise doing things they don’t remember—like online shopping or calling friends—on occasions when they took the sleeping pill while they were still up and about. Avoid “Ambien amnesia” by getting in bed before you take the pill.
Don’t rely too heavily on over-the-counter (OTC) remedies. If you’ve browsed the drugstore aisles lately, you may have noticed that Tylenol PM, Advil PM and Nyquil now offer versions without the painkillers, expanding your options for OTC sleep aids. But be aware that these remedies work differently than a prescription sleeping pill. “Most have an antihistimine in them, which can be sedating,” Fleishman says. “But those can have significant hangover effects.” To mitigate morning drowsiness, make sure you have at least 7 hours to sleep before you take one. And never use them on a long-term basis without consulting your doctor.
Do ask your doctor about a medication called Intermezzo if you tend to wake up in the middle of the night. The 7-hour rule that applies to most sleeping pills can be frustrating if you fall asleep with no trouble, but tend to bolt awake a few hours later. There is at least a temporary solution: Intermezzo, a low-dose variation of Ambien, whose effects only last about 4 hours.
Do see a doctor if your insomnia lasts longer than a few weeks. “Everyone has brief periods where they don’t sleep,” says Fleishman. “But after two weeks, it’s time to go see your doctor. It could be an underlying medical problem.”
Don’t use a sleeping pill more than 5 nights a week—even if you have a prescription. Sleeping pills can be the answer to an insomniac’s prayers, but be careful about relying on a prescription too much, or you could be training your body not to sleep without help. “With some of these medications, you can develop a tolerance over time,” Fleishman says. “So try to go at least two nights a week without them—even if it means you don’t sleep very well on those nights.”
Do practice good “sleep hygiene.” We love this term that sleep doctors use to describe best practices for sleeping. Think of them as just as crucial as brushing your teeth or washing behind your ears! Some of the highlights: Cut back on alcohol and caffeine, don’t eat or exercise too late at night, don’t nap and don’t sleep too late. “Humans are wired to be up in the morning,” Fleishman says. “The early morning sun helps reset your brain’s clock.”
Don’t lose faith. While there’s no evidence that sleep aids are physically addictive, occasionally people become psychologically dependent on taking a pill to help them sleep. “If you’re worried about sleep, and taking a sleeping pill helps, sometimes people think, ‘If I don’t take it, it’s not going to happen,’” Fleishman says. If you find yourself in that boat, it may be time to talk to your doc about your sleep hygiene and other behavioral strategies, which can be very effective.