The Rise of Ambien: Why More Americans Are Taking the Sleeping Pill and Why the Numbers Matter

Last week, a study was released with some staggering news about the potential growth of a danger associated with prescription sleeping pills -- Ambien, in particular.
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Last week, a study was released with some staggering news about the potential growth of prescription sleeping pills -- Ambien, in particular.

Since its arrival on the scene in 1993, Ambien has become one of the most popular prescription sleeping aids. It's a favorite of insomniacs, shift workers, and business travelers, and many of the increasing number of Americans who just can't get to sleep.

But the insidiousness of this drug, the way it has become as much a part of everyday life as acetaminophen or ibuprofen (but without equal levels of safety), has flown under the radar -- until now.

According to data reported by the Substance Abuse and Mental Health Services Administration, the number of people seeking ER care due to adverse reactions to the sleeping aid zolpidem (the active ingredient in Ambien) had increased a dramatic 220 percent in the past five years.

Of course, it's not news that men and women across the U.S. are having a harder and harder time getting the sleep they need. Our world is full to the brim with stimulation -- bright lights and big screens, alerts and messages, and media in every direction we look. This reality has been growing bigger (remember how expensive a big-screen TV was in 1995?) and farther (you'd be hard-pressed to find a country without smartphones these days) year over year in the past two decades.

It's easy to imagine, for example, having a hard time sleeping in this house.

But it's not always as obvious as club music and synchronized light effects. There are more insidious ways technology creeps into your sleep.

When's the last time you checked your phone for new messages, the weather, or to see if it's your Words With Friends move? If you're like most people, it was probably not too long ago.

According to a recent survey, 54 percent of Americans check their phone while they're in bed, either before they go to sleep or on waking in the middle of the night. And about 75 percent of young people fall asleep every night with their phone within reach.

Using your phone -- and watching TV and using your computer and, well, pretty much anything with a screen -- has been proven over and over again to disrupt sleep patterns. In fact, a 2007 study funded by cellphone manufacturers themselves found that participants who were exposed to cellphone radiation prior to bedtime had a harder time falling asleep.

But instead of addressing the problem at its root cause, we've done the very modern thing of trying to patch the hole. We're looking for a quick fix. We don't want to replace the piping; we just want to slap some duct tape on it and hope it doesn't blow up in our faces. It's easier to pop a pill, after all, than change all of our daily habits. After all, it's pretty fun to watch Game of Thrones in bed before falling asleep.

And it's not just a few people taking these drugs. A lot of us want the duct tape. According to IMS Health, a lead research firm that tracks pharma sales, 60 million prescriptions for sleeping pills were prescribed in 2011.

The CDC estimates that "50-70 million U.S. adults have sleep or wakefulness disorder." These numbers are striking, because they essentially mean that for every adult with a sleep disorder, a doctor is writing a prescription for sleeping pills.

Now, clearly there is some disconnect here. There are three likely scenarios that can help explain:

Scenario 1

Sleep disorders are vastly underreported, and there are likely many more than 70 million Americans who are not getting adequate sleep.

After all, can you think of anyone you know who gets the recommended seven to nine hours per night of sleep every day of the week? It's likely that millions of Americans suffer from sleep disorders without even knowing it -- imagine all the people you know solving their sleeping problems with OTC remedies like melatonin or, worse, the cold two-glasses-of-wine insomnia remedy. In addition, 60 million drug prescriptions don't necessarily mean 60 million individuals were prescribed drugs -- in fact, because of restrictions on the number of refills that doctors can prescribe for these sleeping pills, it's very possible that a single Ambien-taker is getting more than one prescription annually.

Scenario 2

Sleeping pills are overprescribed. In other words, lots of Americans who don't have sleep disorders are getting prescriptions for Ambien, Sonata, and Lunesta.

Let's be real here. Ambien is barely considered a drug. It's not uncommon for friends to share a prescription ("Hey, I have to take a redeye tomorrow; do you have any Ambien?") and many doctors will hand the scrips out on request.

Between 2006 and 2011, sleeping pill prescriptions rose from 47 million to 60 million in the U.S. About 38 million of those prescriptions were for drugs containing zolpidem (including the brand name Ambien) according to IMS Health.

Scenario 3

A combination of Scenario 1 and Scenario 2. Sleep disorders are underreported and sleeping pills are overprescribed.

This is the most likely situation, because here's the bottom line: fewer Americans are sleeping than the numbers show and too many are taking Ambien to fix it.

We're going to need a new solution to the problem, because the laissez-faire attitude around zolpidem is beginning to come to a head. Besides the increased hospitalization rates (which, actually, are still relatively few), studies are starting to show that not only is Ambien bad for your health, it's mostly ineffective.

A 2012 study published in the British Medical Journal caused a stir when it announced that those who take prescription sleeping pills on a regular basis were five times as likely to die over a period of two and a half years and to develop cancer. Then, in early 2013, the U.S. Food and Drug Administration (FDA) announced that all companies making zolpidem-based drugs had to significantly lower doses -- a hard 50 percent cut in dosage for women and a mandatory label change recommending doctors prescribe the same lower dose for men as well.

The decision was made after the FDA discovered that the drug stays in the body longer than previously thought, causing people to wake up drowsy the next day. Turns out people were waking up, getting in their cars to go to work, and falling asleep at the wheel. It's especially an issue for women, whose bodies seem to absorb the medication for longer -- and have many, many more problems with insomnia in general.

Even more surprising: studies show that zolpidem may not actually cure insomnia. In clinical trials, those taking zolpidem were only slightly more likely to get more than six and a half hours of sleep than those taking a placebo.

It's not that the duct tape works for a while, and then falls off the pipes after a few years. It's that it doesn't keep the water flowing to begin with.

So if you're having problems sleeping, talk to your doctor. But also consider thinking about your daily habits and patterns. As much as it hurts, don't watch or use any screens for an hour or two before your bedtime. Leave your laptop and cellphone in the living room (get an alarm clock if you're used to using your phone as a clock). Think carefully about what you eat -- a few dietary changes can make all the difference. For example, here are 10 foods that could potentially contribute to insomnia.

And take it seriously. You probably wouldn't pop a friend's antidepressant when you feel down; why would you take her sleeping pills when you feel overtired?

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