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Halcion and other sleeping pills.

An estimated 20 to 40% of all adults have trouble sleeping. According to a recent review in the New England Journal of Medicine of more than a hundred studies of insomnia, 17% of the sleepless consider the problem serious. Furthermore, "insomnia is more prevalent in women, and its prevalence increases with age and socioeconomic class." Which doesn't mean that younger men with blue collar jobs never have insomnia. Nearly everybody has it at some time.

Insomniacs may already be familiar with the tips for preventing or curing insomnia listed in the box at right. Excellent advice, you may say, but it doesn't always work. Tired of feeling tired, millions turn to sleeping pills (or hypnotics, as these medications are known). Is this a good idea? What, if anything, should you take?

Over-the-counter sleeping pills. Most such drugs are anti-histamines (just like many hay-fever remedies, which may also induce drowsiness) and are probably harmless at the suggested dosage. It won't hurt to try them for occasional sleeplessness--they may work for a night or two--but studies show that they quickly lose their effectiveness.

L-tryptophan. This so-called "natural" sleeping pill, once sold in health-food stores, is an amino acid (one of the essential building blocks of protein). The theory was that the body converts tryptophan to serotonin, a neurotransmitter or brain chemical that induces drowsiness. But taking tryptophan does not induce drowsiness, and the side effects of large doses include nausea and vomiting. The drug was taken off the market in 1989 when a contaminated batch was shown to cause a rare blood disease.

Seconal, Nembutal, and other barbiturates. Though once widely prescribed as sleeping pills, these drugs are no longer used for this purpose. They proved to be highly addictive and are almost always fatal in overdose.

Halcion and other tranquilizers (benzodiazepines). Marketed under such names as Valium, Klonopin, Xanax, Dalmane, Restoril, and Halcion, these prescription anti-anxiety drugs really do act as sedatives and are very widely prescribed for people suffering from insomnia. They are less likely than barbiturates to be lethal in overdose, or to create physical dependency. But long-term users do experience some dependency and will usually have withdrawal symptoms when they stop taking the drugs. And many side effects have been reported for all benzodiazepines--disorientation, confusion, "hangover" the next day, blurred vision, nightmares, and daytime depression. The drugs cease to work when taken every night.

Halcion, a short-acting benzodiazepine (its sedative effects last about three hours), has recently been under fire for causing serious psychiatric side effects and was taken off the market in the United Kingdom. Canada did not ban it but placed restrictions on the strength of the dosage that could be prescribed and the duration of use (14 days maximum). In this country the FDA did not take Halcion off the market but did require the manufacturer to provide more explicit information to consumers about the risks and benefits of the drug. In a recent statement the FDA said it still believes that the benefits of Halcion outweigh the risks, but "in no sense should this suggest that Halcion is free of side effects." It may be no more dangerous than other drugs in this category, but since it is more widely used, more side effects are reported.

If, for some reason, you and your doctor decide you need one of these drugs, try a low dose first, and don't take it for more than three nights in a row. Never combine it with alcohol. A physician who's truly interested in your welfare will not automatically renew your prescription, but will want to find out if your problem has cleared up. Your goal should be to reestablish normal sleeping habits without drugs.
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Title Annotation:includes related article on a program for sleep
Publication:The University of California, Berkeley Wellness Letter
Date:Jul 1, 1992
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