Is the long-term use of sleeping pills safe?

MEDICAL MATTERS

Staying Healthy

December 23, 2005|By JUDY FOREMAN | JUDY FOREMAN,MEDICAL MATTERS

Is long-term use of sleeping pills safe?

Is it OK to take sleeping pills for extended periods?

Yes, at least some kinds.

So far, the only sleeping pill approved by the Food and Drug Administration for long-term use is Lunesta, which has been shown to remain effective for at least six months, unlike some drugs that lose their effectiveness over time, prompting people to take increasing doses.

But two other medications chemically similar to Lunesta - Ambien and Sonata - are probably just as safe to take long term, researchers say, though they haven't been specifically studied for that.

All three drugs are selective nonbenzodiazepines, which means they are chemically different from the benzodiazepines (such as Valium), which were once vastly overprescribed.

Some researchers, such as Edward Stepanski, director of the Sleep Disorders Service and Research Center in Chicago and a board member of the American Academy of Sleep Medicine, believe that at normal doses, neither the benzodiazepines nor the nonbenzodiazepines are addictive in the sense that they cause physiological withdrawal symptoms when a person stops using them.

Others, such as Dr. John Winkelman, medical director of the Sleep Health Center at Brigham and Women's Hospital in Boston, disagree, arguing that even the milder drugs "probably do cause physiological withdrawal briefly."

Some people do become psychologically dependent on the pills, said Stepanski, who gets research funding from several companies that make sleeping pills.

There are no studies of people using these drugs for years and years, "But the anecdotal evidence is that there is no harm in doing so," Stepanski added.

The big advantage of the Lunesta, Sonata and Ambien is how quickly the body gets rid of them, said Winkelman.

Sonata has the shortest "half-life," which means it is substantially gone from the body in about four hours - great if you've got only four hours to sleep but not as good if you're trying to sleep for eight, said Winkelman, who consults for the manufacturers of all three drugs. Ambien lasts a bit longer and Lunesta, the longest - about 8 hours in older people.

Don't be afraid of sleeping pills if you have chronic or acute insomnia. But take them according to instructions and call your doctor if you develop problems.

Are the blood pressure machines in supermarkets reliable? Are the home kits?

The blood pressure machines in supermarkets are generally not reliable because it's impossible to know how well-maintained they are. But the kits for home use are, and hypertension specialists recommend them for anyone who needs to monitor blood pressure regularly.

"I encourage patients to do home monitoring," said Dr. Randall Zusman, director of the hypertension service at Massachusetts General Hospital. "It gives patients feedback and tends to promote compliance" with medications and efforts to stick to a good diet and exercise program.

Home machines may also give more typical readings than those obtained in a doctor's office because a person is less likely to exhibit "white coat hypertension," the rise in blood pressure due to the stress of being at the doctor's office.

Studies in recent years have shown that the good home kits correlate well - within 5 millimeters of mercury - with the readings obtained in doctors' offices, said Dr. Roger Blumenthal, director of preventive cardiology at the Johns Hopkins Medical Institutions.

High blood pressure is a major risk factor for stroke, heart attack and kidney disease. Normal blood pressure is defined as a reading of 120 mm over 80 mm. High blood pressure is a reading of 140 systolic (the upper number) over a diastolic (the lower number) reading of 90.

Numbers between 120 over 80 and 140 over 90 are a potential sign of pre-hypertension and may suggest treatment is necessary. Nearly everyone over 55 will eventually become hypertensive, said Zusman.

It's a good idea to bring your home kit to the doctor to calibrate it with the doctor's machine. According to the June 2003 issue of Consumer Reports, the most reliable home kits (which cost $35 and up) use automatic arm cuffs. Those using wrist cuffs or arm cuffs that had to be inflated by squeezing a bulb were less dependable.

Send your questions to foreman@baltsun.com.

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