McCall, who presented these findings to the NIH panel, said that this change is probably related to the fact that antidepressants are far easier to prescribe. The FDA requires stricter safeguards on sleeping pills because they carry the risk for addiction and abuse. As a result, McCall said, "doctors are more vulnerable to prosecution when they give these drugs for a prolonged time."
Yet, unapproved treatments for insomnia are not without their own risks, he pointed out. Desyrel, for example, is associated with low blood pressure. This can be especially troublesome for older people, where a rapid drop in blood pressure can lead to dizziness and falls. Various sedatives can make people feel groggy the next morning, and in the case of using the anti-anxiety drug Ativin, this sluggishness can last one or two days.
"My personal concern is that many patients are being treated with unproven medications," said Leshner.
How to Really Treat Insomnia
Leshner and other NIH-panel members said that the one of the best ways to treat insomnia does not rely on drugs at all. Cognitive behavior therapy, which combines two forms of psychological methods, has proven highly effective at combating insomnia. The cognitive part trains people to understand how their thinking can cause sleep problems, while the behavioral component helps them overcome sleepless situations. The only trouble is finding a practitioner who is skilled enough to teach these methods. Insomnia patients can turn to psychiatrists and sleep specialists as a resource.
Although many restless sleepers turn to over-the-counter remedies, such as antihistamines or herbal remedies, like melatonin and valerian, experts say there is little evidence that these work for insomnia. McCall agreed that cognitive behavior therapy should be the first choice, but it takes weeks to learn, and when faced with needing a good night of sleep immediately, many will want to take the easy route.
"Changing behavior is a lot harder than taking a pill." he said.
One sleep drug, Lunesta, can be safely used for at least six months, according to the FDA. Dr. Charles Zorumski, a psychiatrist at the Washington University School of Medicine who was on the NIH panel, said that Lunesta and other new sleeping pills appear to have less potential for abuse than the older drugs. Still, he cautioned, "they are a controlled substance."
Given the concerns about growing dependent on sleeping pills, McCall recommends using the lowest dose over the shortest amount of time.
"It’s like Cinderella finding that perfect fit," he said.
