10/24/2007 01:15 PMSleep Drugs Found Only Mildly Effective, but Wildly Popular - New York TimesPage 1 of 4http://www.nytimes.com/2007/10/23/health/23drug.html?ref=science&pagewanted=printOctober 23, 2007Sleep Drugs Found Only Mildly Effective, but Wildly PopularBy STEPHANIE SAULYour dreams miss you.Or so says a television commercial for Rozerem, the sleeping pill. In the commercial, the dreams involveAbraham Lincoln, a beaver and a deep-sea diver.Not the stuff most dreams are made of. But if the unusual pitch makes you want to try Rozerem, considerthat it costs about $3.50 a pill; gets you to sleep 7 to 16 minutes faster than a placebo, or fake pill; andincreases total sleep time 11 to 19 minutes, according to an analysis last year.If those numbers send you out to buy another brand, consider this, as well: Sleeping pills in general donot greatly improve sleep for the average person.American consumers spend $4.5 billion a year for sleep medications. Their popularity may lie in amystery that confounds researchers. Many people who take them think they work far better thanlaboratory measurements show they do.An analysis of sleeping pill studies found that when people were monitored in the lab, newer drugs likeAmbien, Lunesta and Sonata worked better than fake pills. But the results were not overwhelming, saidthe analysis, which was published this year and financed by the National Institutes of Health.The analysis said that viewed as a group, the pills reduced the average time to go to sleep 12.8 minutescompared with fake pills, and increased total sleep time 11.4 minutes. The drug makers point to individualstudies with better results.Subjects who took older drugs like Halcion and Restoril fell asleep 10 minutes faster and slept 32 minuteslonger than the placebo group. Paradoxically, when subjects were asked how well they slept, they reportedbetter results, 52 extra minutes of sleep with the older drugs and 32 minutes with the newer drugs.“People seem to be getting a lot of relief from sleeping pills, but does getting 25 minutes of sleep reallygive you all that relief?” asked Dr. Wallace B. Mendelson, the former director of a sleep disorders unit atthe University of Chicago. “A bigger aspect of this is that they change a person’s perception of their state ofconsciousness.”Dr. Mendelson is semiretired and is a consultant for pharmaceutical companies.Dr. Karl Doghramji, a sleep expert at Thomas Jefferson University in Philadelphia, agreed. “Sleeping pillsdo not increase sleep time dramatically, nor do they decrease wake time dramatically,” he said. “Despitethose facts, we do find patients who, when they take them, have a high level of satisfaction.” Dr.Doghramji has disclosed in the past that he is a consultant to pharmaceutical companies.10/24/2007 01:15 PMSleep Drugs Found Only Mildly Effective, but Wildly Popular - New York TimesPage 2 of 4http://www.nytimes.com/2007/10/23/health/23drug.html?ref=science&pagewanted=printMost sleeping pills work on the same brain receptors as drugs to treat anxiety. By reducing anxiety, thepills may make people worry less about not going to sleep. So they feel better.Another theory about the discrepancy between measured sleep and perceived sleep involves a conditioncalled anterograde amnesia. While under the influence of most sleep medications, people have troubleforming memories. When they wake up, they may simply forget they had trouble sleeping.“If you forget how long you lay in bed tossing and turning, in some ways that’s just as good as sleeping,”said Dr. Gary S. Richardson, a sleep disorders specialist at Henry Ford Hospital in Detroit who is aconsultant and speaker for pharmaceutical companies and has conducted industry-sponsored research.Sleep, after all, causes a natural state similar to amnesia, one reason toddlers often forget their violentnightmares by the next morning. If you stay in bed, as most people taking sleeping pills do, amnesia is nota bad thing.Even some people who sleepwalked while taking Ambien, which was implicated in cases of odd,sometimes dangerous behavior while sleeping, believed they were having a good night’s sleep. RosemaryEckley, a graphic artist in New London, Wis., said she thought she was sleeping well on Ambien but woketo find her wrist broken, apparently in a fall while sleepwalking, she wrote in an e-mail exchange.Reports of sleep-eating and sleep-driving on Ambien are reminiscent of problems nearly 20 years agowith Halcion. Some people who took that drug to sleep on airplanes developed a condition known astraveler’s amnesia. They landed at their destinations, then got lost or forgot where they were, promptingthe authorities in several countries to withdraw Halcion from the market.Reports show that Ambien and similar drugs, advertised as safer than benzodiazepines like Halcion, cancause similar problems. The reports prompted the Food and Drug Administration to ask manufacturers todevelop warning guides for distribution with virtually all sleep drugs. Despite such problems, mostspecialists say sleeping pills are generally safe. Dr. Mark W. Mahowald, director of the Minnesota RegionalSleep Disorders Center, which is involved in documenting cases of sleep-eating under the influence ofAmbien, said serious side effects were rare and should not discourage the use of the pills.The class of drugs known as nonbenzodiazepines, sometimes called “Z” drugs, includes Ambien, Lunestaand Sonata. Ambien and its generic equivalent, zolpidem, are the most widely used, together accountingfor 40 percent of the market.Newer drugs like Lunesta and Ambien CR, a controlled-release formula, cost about $4 a pill. Zolpidemrecently sold for $2 a pill on walgreens.com.Of the three drugs in the class, Sonata, which also retails for about $3.50 a pill, remains in the body theshortest time and, therefore, is normally used by people who have trouble falling asleep but no problemstaying asleep. The advocacy organization Public Citizen’s Health Research Group says its benefits are sominimal it should not be used.King Pharmaceuticals, the maker of Sonata, did not respond to several messages seeking comment.A study by an Oregon State University group that reviews the safety and effectiveness of drugs found thatLunesta offered little benefit over generic Ambien or older benzodiazepines, but cost more. Jonae Barnes,10/24/2007 01:15 PMSleep Drugs Found Only Mildly Effective, but Wildly Popular - New York TimesPage 3