Question: I have been having trouble sleeping, and my doctor prescribed Ambien. But I've also heard reports of people having trouble with this drug. Is it safe?
Dr. Hibberd's Answer:
Sleep agents are commonly prescribed and can have very significant side effects. Some have serious drawbacks that aren't recognized until years later.
Until recently, most of the popular sleep agents obtained by prescription have belonged to the hypnotic group of drugs (both benzodiazepine and non-benzodiazepine groups). The drugs have been overused to the point of abuse, and some are actually associated with memory loss. They can cause addiction, withdrawal symptoms, and are approved for short-term use only. They are often prescribed on an extended basis simply because doctors have limited options.
Ambien belongs to this group. Drugs like Ambien are safe only for short-term use in select patients. Avoid using it if you're pregnant. They are classified as central nervous system depressants and should not be mixed with alcohol or other depressants. Study the product insert for the host of potential side effects.
Many patients first try non-prescription, over-the-counter medications to deal with insomnia. These products are only marginally effective and can cause serious side effects, including impairing REM (rapid eye movement) sleep, thereby causing poor-quality sleep.
Anytime you can avoid using prescription drugs by altering your lifestyle and habits, you're better off doing so. I suggest you consider proven, established remedies:
• Avoid caffeine. (I have always been amazed by patients who say they can't sleep, don't know why, and then we find out they drink several cups of coffee a day!)
• Avoid heavy late-night dinners. Eat light and early for dinner.
• Exercise strenuously immediately before bed, and/or exercise before dinner.
• Avoid working in your sleep area. Sleep where it is as quiet and dark as possible.
• Try to establish a regular sleep pattern, which will help regulate your body.
Finally, if lifestyle changes don't work, consult your physician about ramelteon (Rozerem). Although this new drug is classified as a hypnotic agent, it works as a melatonin agonist. Our brains normally secrete melatonin in small quantities to regulate our sleep cycles. Until recently, there has been no effective method of significantly affecting this brain hormone. Airline pilots have been using variable amounts of extracts containing melatonin-like substances for jet lag, with reported benefits, for years.
Although Ramelteon does have contraindications and adverse effects, there is no short-term caution attached to its use. Talk with your doctor to see if it might be appropriate for you.
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