Getty Images (2); Photo Illustration by Kim Bubello for TIME
Depends on your symptoms. But experts say any pill is a short-term fix, not a solution.
Something is keeping Americans up at night. More than one third of adults regularly don’t get enough sleep, and 25% percent of kids have difficulty sleeping. The causes of those sleep issues vary—from the sleep-suppressing blue light of a smartphone to the effects of booze—and they’re hard to pin down. But whatever the cause, more and more of us, particularly women and seniors, are turning to sleeping pills for relief. But which one is best? The one you only take for a week or two, experts say.
Pills are a bandage, not a cure, says Dr. Phyllis Zee, professor of
neurology and sleep medicine at Northwestern University’s Feinberg
School of Medicine. “It’s like taking Tylenol every day for a fever
without ever figuring out what’s causing the fever,” Zee says.
Depression, too little exercise, runaway stress and a hundred other
major or minor health issues could be causing or contributing to your
sleeping woes. When you attack your problem with pills, you do nothing
to resolve those underlying problems, she explains. What does work, says Zee and the six sleep experts I contacted for
this story, is cognitive behavioral therapy for insomnia, or CBT-I. is
the most effective long-term treatment for sleep woes.
“By far the best
evidence we have when it comes to resolution of insomnia is associated
with
CBT-I, which is why every major medical authority advocates CBT-I
as the first-line treatment for insomnia,” says Michael Grandner,
director of the Sleep and Health Research Program at the University of
Arizona College of Medicine.
CBT-I interventions can range from
cutting out all screen time an hour before bed to visiting a sleep
clinic every week. “But basically, it advocates having a regularized
time and routine surrounding bedtime,” says Dr. Namni Goel, a sleep
researcher at the University of Pennsylvania School of Medicine.
While every person with sleep issues should be employing CBT-I, Goel
and others agree there’s a time and place for sleeping pills.
For short stints—a few nights for a week or two—a prescription
hypnotic like Ambien or Lunesta can help you get some rest if you’re
stressing about a big event, like your upcoming wedding or some
especially hectic period at work, Grandner says. He also says keeping
some on hand and taking a pill once every couple months if you’re really
desperate isn’t too problematic. “The real concern,” he says, “is
taking these pills on a weekly or monthly basis for an extended period
of time.”
He mentions research
linking these drugs to higher risks of death. That research is
preliminary and incomplete, he says. “But it’s pretty well established
that the kind of sleep you get on a drug like Ambien or is not as deep
or restorative as natural sleep,” he adds. “I think it’s safe to say
anything that drags you kicking and screaming into unconsciousness is
not without risks.” Goel says these types of drugs have also been linked
with memory and mood problems. Use them too much, and they may be
habit-forming—meaning you can’t get to sleep without them, she adds. Apart from hypnotics, more and more doctors are prescribing mild
antidepressant drugs for sleep disorders. “The most common one is
trazodone, which is considered quite safe and has a mild sedative
effect,” Grandner says. “But at the same time, it’s not approved by the
FDA to treat insomnia, and I don’t think a lot of doctors writing these
trazodone prescriptions realize we have almost no good evidence to
support its use as a sleep aid.”
Another newer class of sleep drug—a
type called “orexin receptor agonists” that block a brain chemical that
keeps you awake—could turn out to be a game-changer. But these drugs are
so new that their long-term benefits and risks aren’t well understood,
Grandner says.
Melatonin
is another, mellower option. But while many people think of the hormone
as natural and “something my body makes anyway,” it’s still something
that should only be used for temporary relief, says Dr. Andrew Weil,
founder and director of the Arizona Center for Integrative Medicine at
the University of Arizona. “Short-term use of melatonin has a good
safety profile in adults,” Weil says. But the side effects of long-term
or heavy usage aren’t well known, he adds.
The effect melatonin may have on kids is even murkier. “I’ve been
treating kids in sleep clinics for 25 years, and I’ve just seen an
explosion in melatonin use the last five years,” says Dr. Judith Owens,
director of the Center for Pediatric Sleep Disorders at Boston
Children’s Hospital.
For adults, Grandner says the best evidence suggests taking 0.5 to 1
mg of melatonin a few hours before bedtime. “The idea is you want to
take it right around the time your system should naturally start
producing the hormone,” he says. Especially in older adults, whose
bodies may no longer make enough melatonin, taking the supplement in the
evening may be helpful “if they’re not getting a good night’s sleep,”
he says. But in higher doses taken right before bed, both he and Weil
say taking melatonin may actually disrupt sleep. The kind of deep, restful, rejuvenating sleep we all want isn’t going
to come from a pill.
You’ll have to make some changes if you want to
catch some ZZZs.
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