Sleep aids: A look at prescriptions

Let's face it. Sleep is one of those issues that is not so easily dispatched with images of puppy dogs and tropical islands. We need our restorative sleep in order to fight the battle, and there are times when only a pill will do.

Now and then an Aging Warrior needs to remember what Jefferson Airplane and the Door Mouse said: "Feed your head, feed your head!"

But before we get carried off by a glowing Lunesta butterfly, perhaps we should do a little investigation of what these little helpers can do -- and what they can't do -- for us.

There has been a sharp increase in Americans taking these prescribed meds. Nine million people take the nighttime dose annually, and that's a 3 million person increase in the past five years. According to the National Institute of Health, 70 million Americans have trouble sleeping, with 60 percent qualifying for a chronic sleep disorder.

There are three classes of prescribed sleep aids currently available. Let's take a look behind the hype with the help of last month's Medical Letter, the best source of objective information when it comes to pharmaceuticals.

Benzodiazepines (Dalmane, Ativan). These are among the most prescribed and among the most abused meds in the United States.

They've been around for a while and are effective at decreasing the time it takes to fall asleep. They are available in generic form which makes them cheaper than the newer sleep medications being touted endlessly on television. Their effectiveness can last for weeks, even months.

Yet with higher doses over longer periods of time, one can veer quickly into the Valley of the Dolls. Getting off them can be difficult; combining them with alcohol can be deadly.

NBRAs ("nonbenzodiazepine benzodiazepine receptor agonists," if you must know). Ambien is the leader of this pack. It acts fast to put you to sleep but doesn't necessarily help with sleep maintenance. Just as its patent is set to expire this year, they have come out with a new formulation -- Ambien CR -- which is supposed to be time released to take care of this problem.

Lunesta, with that ubiquitous glowing butterfly on TV, is the newest NBRA on the market. Its claim to fame is that, unlike the other two, you can potentially cause next-day drowsiness.

Sonata, as the shortest acting NBRA, may solve one of the biggest problems with sleep we have as we age: sleep maintenance. The Medical Letter recommends taking a short acting NBRA (such as Sonata) when you awake in the middle of the night (as opposed to when you go to sleep.) According to them, Sonata has a low risk of next-day residual effects, even when taken in the middle of the night.

Ramelton (Rozerem) is a new kid on the block. It activates the same receptors as melatonin, the natural sleep regulating hormone in our bodies that tends to wane as we age.

Unlike the other two classes of sleep aids, it is not a controlled substance and has no potential for abuse. It hasn't been around long enough to be well studied and its hypnotic effect is milder than others. According to the Medical Letter report, it can improve the time it takes to fall asleep, but -- wouldn't you know it -- not sleep maintenance.

I don't know about you, but I am still tossing and turning when it comes to finding an effective sleep aid. Next week, I keep up the hunt, turning to what my Aunt Dorothy sneeringly called "patent medicines" (over-the counter) as well as natural supplements.

Until then, at least don't let the bed bugs bite.