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Should I take Lunesta to help me sleep?
Q. I have chronic problems sleeping. I hear that Lunesta, a sleeping pill, can be taken long-term. Is that true? Do you recommend it?
A. Lunesta (eszopiclone) is the newest member of a class of prescription sleeping pills called nonbenzodiazepines, which includes zolpidem (Ambien) and zaleplon (Sonata)-also known as Z drugs. These drugs have risen rapidly in popularity, overtaking benzodiazepine medications such as lorazepam (Ativan) and temazepam (Restoril). One of the problems with the older benzodiazepine drugs is that people develop tolerance if they're taken for longer than 10 days. If you take them regularly, you may need to keep raising the dose to get the same effect.
Benzodiazapines can also cause rebound insomnia (a recurrence of sleep problems after stopping the drug) and other withdrawal symptoms (for example, nightmares resulting from the drugs' interference with REM sleep, the time when we dream most vividly). Nonbenzodiazepines bind more selectively to sleep-regulating receptors in the brain and disappear more quickly from the body, producing fewer side effects. In particular, they're less likely to cause tolerance, withdrawal symptoms, or rebound insomnia.
Lunesta has gotten a lot of attention because it's the only nonbenzodiazepine that's been approved by the FDA for as long as six months of nightly use. Ambien and Sonata, the other drugs in this class, are approved only for short-term use (less than 35 days). A large controlled study found that Lunesta improved sleep quality for up to six months without causing tolerance. For most adults, the standard dose is 2-3 milligrams (mg) at bedtime, although older women may do better with just 1 mg. The drug's most common side effects are headache and a bitter taste in the mouth.
The widespread appeal of a sleeping pill that can be used night after night is not surprising. According to the NIH, more than 70 million people in the United States have a sleep disorder, and for 60%, it's a chronic problem. These figures haven't been lost on the pharmaceutical industry. The makers of prescription sleep medications spent more than $61 million to market their pills in 2004 and over twice that in 2005. In an analysis of prescription drug insurance claims from 2.4 million Americans, Medco Health Solutions, Inc. (a health benefits management company) found that the number of adults using sleeping pills doubled between 2000 and 2004-and most of the users are women. In the 20-64 age group, for example, 58% more women than men used sleep medications in 2004.
There's no question that getting adequate sleep is important for good health. But before you reach for a sleeping pill, be sure you aren't falling prey to advertising that plays on your anxiety about not getting the recommended seven to nine hours of sleep. While sleeping pills can be very helpful for occasional, short-term use, they are not the first line of defense against insomnia. All pills have side effects and may interact with other medications. Even the nonbenzodiazepines can cause some rebound insomnia and changes in normal sleep patterns, which could affect memory and learning in the long run. Lunesta has only been approved for six months of use-not a lifetime of insomnia.
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Good sleep habits
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If you have chronic insomnia, the first thing to do is find out if the cause is a treatable condition, such as heart disease, asthma, sleep apnea, restless legs syndrome, depression, or anxiety. Investigate whether something else-such as alcohol, caffeine, tobacco, or medications-is interfering with your sleep. And practice good sleep hygiene (see box, "Good sleep habits").
To wind down for sleep, try a warm bath (as long as hot flashes aren't a problem for you) or a few minutes of reading in a comfortable chair. You might also find it helpful to learn the "relaxation response," a technique developed by Dr. Herbert Benson at the Harvard Medical School.
- Celeste Robb-Nicholson, M.D. Editor in Chief, Harvard Women's Health Watch
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| Last updated: | August 21, 2006 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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