What is sleeping pill addiction?

History of Use

Zolpidem (Ambien), a nonbenzodiazepine sleeping aid, was approved as a prescription by the US Food and Drug Administration in 1992. Zapelon (Sonata) was approved in 1999 and eszopiclone (Lunesta) was approved in 2004. Since the introduction of zolpidem, there have been reports of diversion and abuse because of the addictive nature of these medications. When abused, these medications are often combined with alcohol or other sedating drugs, which heightens adverse reactions.

Effects and Potential Risks

Zolpidem, zapelon, and eszopiclone all have mechanisms of action involving the GABA-A receptor within the central nervous system, whereas ramelteon (Rozerem) is a selective agonist of melatonin. Chemically, zolpidem and zapelon bind specifically to a1 subunits on GABA-A receptors.

Generally, these medications are indicated only for short-term management of insomnia and should be ingested only when the patient will get at least seven to eight hours of uninterrupted sleep. However, because of their addictive properties, these medications are often used for extended periods of time. Of the three sleeping medications, the only one that does not include a labeling restriction for short-term use only is eszopiclone. Overall, this medication has less potential for abuse or dependence in most patients.

Common adverse effects of this class of medications include daytime sedation, drowsiness, cognitive impairment, problems with motor coordination, and dependence. Although reported less frequently, more serious complications include sleep-related behaviors such as sleep-walking, sleep-eating, sleep-driving, and temporary amnesia. There also have been reports of worsening depression and suicidal thoughts, so a complete psychological history is an important factor in the decision of what sleeping medication, if any, to prescribe.

Bibliography

Dolder, Christian, Michael Nelson, and Jonathan McKinsey. “Use of Non-Benzodiazepine Hypnotics in the Elderly: Are All Agents the Same?” CNS Drugs 21.5 (2007): 389–405. Print.

Rosenberg, R. P. “Sleep Maintenance Insomnia: Strengths and Weaknesses of Current Pharmacologic Therapies.” Annals of Clinical Psychiatry 18.1 (2006): 49–56. Print.

Wagner, Judy, Mary L. Wagner, and Wayne A. Hening. “Beyond Benzodiazepines: Alternative Pharmacologic Agents for the Treatment of Insomnia.” Annals of Pharmacotherapy 32.6 (1998): 680–91. Print.