It’s almost inevitable. Toss and turn for long enough, and eventually the middle-of-the-night bargaining will begin—If I fall asleep in the next 10 minutes, I’ll get five hours. Ten minutes pass. Fifteen minutes pass.
So what is there to do? Counting sheep is fine, if you’re relaxed by the idea of farm animals wandering around your room, but otherwise seems kind of ineffective. Warm milk’s another option, though the science on that one is a little iffy, too.
Another answer is sleeping pills. And another answer, for tens of thousands of Americans, is too many sleeping pills, according to a new report from the Substance Abuse and Mental Health Services Administration.
The report observed a dramatic uptick in emergency-room visits related to zolpidem, the active ingredient in Ambien and other prescription sleep aids, from 2005 to 2010 (suicide attempts, bad reactions to the correct dosage of zolpidem, and cases where people had taken the drug without a prescription were not counted). Focusing on “overmedication,” or instances where the patient overdosed solely on zolpidem or used it in combination with alcohol or other drugs, the SAMHSA found that the number of ER visits nearly doubled, from roughly 22,000 in 2005 and 2006 to just over 42,000 in 2009 and 2010.
Women in particular were especially vulnerable, making up roughly two-thirds of all zolpidem-related mishaps. Although women are only slightly more likely to use prescription sleep aids (5 percent of women take them, as opposed to 3.1 percent of men), they’re also slower to metabolize them. Last year, prompted by reports of residual next-day drowsiness, the Food and Drug Administration told sleeping-pill manufacturers to halve the recommended dosage for female patients (it suggested, but did not require, that the companies lower the dosage for male patients as well).
The simplest explanation for the increase in sleeping pill-related hospitalization may be that the use of sleeping pills in general is also on the rise. The number of prescriptions for nonbenzodiazepine sedative hypnotics, a group of drugs to which zolpidem belongs, grew 30 times over between 1994 and 2007—that’s five times faster than the growth of insomnia diagnoses over the same period of time, and 21 times faster than the growth of patient complaints of sleeplessness. Somewhere between 50 and 70 million Americans are currently thought to suffer from sleep disorders, according to the Centers for Disease Control and Prevention, and around 4 percent of adults use prescription medication to get a good night’s rest.
As to why people overdose in the first place—well, according to the report, much of it has to do with frustration at the pills themselves:
Even when taking the recommended dose of zolpidem, some patients find restful sleep difficult to achieve. When sleep does not come easily or is interrupted, patients may take more of their zolpidem medication than is prescribed.
It seems like a reaction to a fairly common grievance. On average, sleeping pills will only add around 11 minutes of sleep time, according to a 2007 study from the National Institutes of Health, and will cause the user to drift off just 13 minutes sooner after getting into bed. As promised, they’re likely to help you go to sleep and stay asleep, but barely.
Another issue is that patients don’t always realize that zolpidem shouldn’t be mixed with certain other drugs, says Dr. Peter Delany, director of SAMHSA’s Center for Behavioral Health Statistics and Quality. (Notably, zolpidem in combination with other drugs accounted for nearly 60 percent of all ER visits measured in the report).
“Patients don’t always remember to tell their doctors that they’re on another medication, because they may be going to multiple doctors for different specialty care,” he explains.
The SAMHSA study authors were slightly less sympathetic, noting that misuse “may occur even though the medication guides for each zolpidem product … contain clear instructions to the patient to take the product exactly as prescribed.”
So, it’s the middle of the night. What do you do? Read the label, says the report. Or put the pills away, and just try and will yourself into believing you’re well-rested the next morning. Or take some solace in the fact that no one really knows how much sleep they get, anyway. Or maybe try the sheep thing again.