The Insomnia Blog - Sleep Doctor Michael Breus, PhD

Zolpidem-related ER visits have increased sharply

There’s more news about complications that can arise from prescription sleep medication: Side effects from a common prescription sleep aid are sending increasing numbers of people to emergency departments. 

The number of people seeking emergency medical treatment for the adverse effects of sleep medications containing zolpidem has risen dramatically in recent years, according to a new federal report. Zolpidem is the active ingredient in several of the most commonly prescribed sleep medications, including Ambien, Ambien CR, Edluar, and Zolpimist. 

The report was issued by the Substance Abuse and Mental Health Services Administration’s Drug Abuse Action Network (DAWN), which collects information about drug-related visits to emergency departments nationwide. Their analysis included all emergency-department visits that involved adverse effects of zolpidem during the years 2005-2010. During this 5-year period, visits to emergency departments involving adverse effects of zolpidem increased significantly, rising by more than 200%. Women and older adults sought emergency treatment for adverse zolpidem effects in greater numbers overall than men and younger adults. According to the report: 

• In 2010, there were 64,175 emergency-department visits involving zolpidem. Of these, 19,487 or 30%--specifically involved adverse reactions to the sleep medication.
• In 2005, there were just 6,111 emergency-room visits involving adverse reactions to the sleep drug. During the period 2005-2010, emergency department visits involving adverse reactions to zolpidem rose almost 220%.  

The analysis found women were significantly more likely to seek emergency treatment for problems with zolpidem than men:  

• Women accounted for 68% of emergency department visits related to adverse reactions to zolpidem in 2010. The differences between men and women fluctuated during the 5-year period, but overall women made up a greater number of the zolpidem-related emergency visits in every year but 2008.
• The number of emergency-department visits made by women involving adverse effects of zolpidem increased by 274% during the years 2005-2010. Visits by men increased 144%.

Age also was a factor, with greater numbers of cases involving older adults: 

• Adults ages 45 and older accounted for 74% of all emergency department visits involving adverse reactions to zolpidem. As a comparison: this same age group accounted for 56% of emergency room visits involving adverse effects of any drug.
• Patients ages 65 and older were the single most common age group to seek emergency treatment for adverse reactions to the sleep medication: 32% of all emergency department visits related to adverse effects of zolpidem were undertaken by people in this age group.
• Patients ages 45-54 were the next largest group, accounting for 22% of all visits. 

Other pharmaceutical drugs often were involved in emergency treatments related to zolpidem. Half of the emergency department visits related to adverse effects of zolpidem involved other medications as well:  

• Of the total visits to emergency departments related to adverse effects of zolpidem, 40% involved the sleep drug alone.
• In 50% of the cases, one or more additional prescription drugs were involved.
• The most common prescription drugs seen in combination with zolpidem’s adverse effects included narcotic pain relievers, anti-depressants, anti-anxiety medications and other insomnia medications.  

The side effects associated with zolpidem can be disorienting, scary, and at times dangerous. These side effects include hallucinations, problems with memory, excessive daytime tiredness, sleepwalking and engaging in other behaviors such as eating and even driving while not fully awake and alert. The adverse effects of zolpidem can be exacerbated when the sleep medication is combined in the body with other common prescription drugs, including narcotic pain relievers, anti-depressants and anti-anxiety medications. Alcohol, too, can have a magnifying effect on the body’s reaction to zolpidem.  

Medications containing zolpidem are prescribed to millions of Americans with sleep problems, in numbers that have been rising dramatically in recent years. The SAMHSA report does not discuss reasons for the spike in zolpidem-related emergency department visits, but it’s certainly likely that the rise in the number of prescriptions may play a significant role. For all their frequent usage, we still don’t know a great deal about the health and side effects of zolpidem medications. Stories about strange and erratic behavior associated with these sleep medications have been widely reported, but research into the effects of zolpidem is just starting to accumulate.  

In January of this year, the Food and Drug Administration issued a safety alert including changes to its regulations regarding zolpidem. The FDA announced it would require drug makers to cut in half the recommended dosages for women taking zolpidem, and suggested that the recommended dosage for men be lowered as well. The alert also urged medical professionals to warn all patients taking zolpidem about early-in-the-day drowsiness and impairment. The FDA’s action came about as a result of research indicating that patients—especially women—who take zolpidem at night may have concentrations of the medication in their bloodstream high enough to cause impairment in the morning for activities such as driving. The research showed that women’s bodies take significantly longer to metabolize the drug, leaving them particularly vulnerable to excessive drowsiness and impairment in the morning.  

Research also has shown that older adults are at greater risk for adverse effects from sleep medications, including those containing zolpidem. The elevated numbers of both women and older adults seeking emergency treatment for problems with zolpidem appears to align with other research suggesting these groups are at elevated risk for complications from these medications. We must continue to learn more about the short-term and long-term effects of zolpidem and other sleep medications on patient safety and health.  

Sleep medications containing zolpidem can be an effective short-term treatment for disordered sleep. But these medications must be prescribed with care and caution by doctors, and used correctly by patients. Prescription sleep medications such as those with zolpidem are not intended for long-term use. For most patients with sleep problems, the best long-term prescription for healthy sleep isn’t found in a pill bottle. It’s found in the fundamentals of strong daily sleep habits, and a lifestyle that promotes good sleep hygiene.

 

Sweet Dreams,

 

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

NHL wakes up to sleep problems

The professional sports world appears to be continuing to turn more of its attention to what has been a much-overlooked issue: sleep. This time, it’s the National Hockey League that is addressing sleep problems on several fronts. 

In response to reports of widespread use, the NHL and the NHL Players’ Association are working together to study the use of Ambien by players in the league. The results of the study are expected later this spring, when the league is expected to issue its findings and make recommendations about use of the prescription sleep medication.  

The issue of sports-related drug use—particularly the performance-enhancing kind—is of course widespread in professional sports these days, and has been for some time. For many years, rightly or wrongly, hockey has been thought of as s sport less riddled with performance-enhancing drugs. But steroids and other performance-enhancing drugs are only part of the drug problem in sports. Prescription drug use—including excessive or inadvisable use of sleep medications—is also a problem in the world of competitive athletics. 

And the NHL is no exception. The death of NHL player Derek Boogaard is a sad and sobering example: the 27-year-old died of a drug and alcohol overdose in 2011. Investigations into his death revealed that he was in possession of a frightening array of drugs, including a dozen or more prescriptions for Ambien, which he’d received from several different doctors. 

Sleep problems are a serious issue for professional athletes, whose intense training, rigorous schedules, and frequent travel across time zones put them at high risk for disrupted and insufficient sleep. Pro athletes crisscrossing the country, often flying overnight before waking up to an early morning practice or next-day game, share risks for sleep problems with other high-frequency travelers and people who work non-traditional schedules. People in these jobs—from law enforcement to doctors and nurses to airline personnel and air-traffic controllers—are at higher risk for sleep disorders such as insomnia and obstructive sleep apnea. They also can be at elevated risk for health problems associated with poor sleep, including obesity, Type 2 diabetes, and cardiovascular disease. 

In addition to studying the use of Ambien, the NHL has also taken other steps to address sleep issues among its players. In its most recent agreement with the NHL Players’ Association, the NHL made changes to league policies that are intended to provide players with better rest during the season. The new rules include a minimum of 4 days off per month during the season, and a minimum 9-hour break between flight touch-down and the beginning of the next practice when players are on the road. While these changes may seem modest, they do appear to reflect a growing awareness of the need to protect athletes’ ability to sleep. It is my hope that they also reflect an understanding that sleep medication is not the first—nor always the best—recourse for improving sleep. 

I wrote last fall about the New York Jets’ decision to hire sleep specialists to work with players on improving their sleep habits, and the sleep-friendly adjustments made to the team’s practice schedule. This is exactly the kind of attention I like to see being put toward improving sleep—the kind that addresses lifestyle changes in manageable, sustainable ways rather than jumping right to sleep medication as the catch-all solution to sleep problems. I hope we see more of these sorts of strategies implemented by professional sports teams and leagues. 

The study of sleep’s effects on sports is relatively new, but there is a growing body of evidence to show that sleep can boost athletes’ performance on their field of play. There is also research that shows how lack of sleep may have negative consequences for athletes: 

• Research at Stanford University’s Center for Sleep Sciences and Medicine has shown sleep linked to measurable improvements to performance across a range of sports. From swimming to basketball to football, collegiate players in these studies improved speed, accuracy, and reaction times when they increased their nightly sleep.  

• There is also research that indicates sleep may play an important role in post-exercise recovery, which is considered a critical to maintaining athletic performance over the course of a season and a career.  

• When professional athletes don’t get enough sleep, they may be shortening the overall lengths of their careers. That’s the message from a pair of studies which found that low sleep was associated with shorter career spans and more frequent trades, in both professional football and professional baseball.  

It’s not that sleep medications like Ambien don’t have any place in the treatment of disordered sleep. They do. But prescription sleep medications need to be carefully prescribed and monitored, and they are rarely, if ever, the best first step in a treatment plan to improve sleep. This is true for the men and women of professional sports. It’s also true for the rest of us, who want to be at the top of our game in our daily lives.

 

Sweet Dreams,

 

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

FDA recommends lower doses of popular sleep medications

Yesterday, the Food and Drug Administration issued an announcement that could affect millions of Americans who take some of the most common medications for sleep. The FDA said it will require drug makers who produce sleep medications containing zolpidem to reduce some of their recommended dosages, cutting them by half.  

Zolpidem is the active component in some of the most frequently prescribed sleep medications on the market, including Ambien, Ambien CR, Edluar, and Zolpimist, as well as generic versions of these drugs.  

The new requirements put specific focus on lowering the recommended dosage for women. This comes as a result of research showing that morning blood levels of the medication may be high enough to reduce alertness and interfere with activities such as driving. The research indicates that women are at higher risk for this morning-after impairment from sleep medications containing zolpidem because it takes significantly longer for women’s bodies to process and eliminate the drug from their systems, compared to men’s. The goal in lowering dosage of zolpidem medications is to lower the levels of the medication in the blood by morning, thereby reducing the risk of early-in-the-day drowsiness and impairment.  

The FDA’s research also indicates that the problem of next-day impairment from zolpidem is greatest with the extended release version of this type of medication, including Ambien CR and generic types.  

Intermezzo, a zolpidem medication released in 2011, is not affected by these changes. Intermezzo, a prescription sleep aid that is targeted for people who wake in the night after initially falling asleep, already carries a lower dose of zolpidem than other medications that are designed to address difficulties falling asleep.  

The FDA also announced that it would continue to research the impairment risks of other prescription medications and over-the-counter sleep aids.  

The required changes to the recommendations dosages for sleep medications containing zolpidem are as follows:

• For women, the recommended dose should be lowered from 10 milligrams to 5 milligrams. For the extended-release versions, the recommended dose should be lowered from 12.5 milligrams to 6.25 milligrams
• The FDA will not require that the recommended dose for men be lowered.However, it suggests that medical professionals warn all patients, men and women, about the risks of morning drowsiness and impairment, particularly for activities such as driving. 

I understand the FDA’s concerns.  But I see a couple of additional issues that may contribute to the early-in-the-day drowsiness and impairment that people experience while taking these sleep medications.  

• Not enough time in bed. Patients who are prescribed sleep medication with zolpidem are not giving themselves enough time in bed for sleep after taking their dose in the evening. In a clinical setting, it is a standard recommendation that people taking this type of sleep medication have a full 8 hours to spend in bed. It would not surprise me if some people who are taking zolpidem are not giving themselves sufficient time for a full night’s sleep, during which time the drug’s effects would subside.
• Patient Compliance. Another possible issue has to do with patient compliance. People who take something other than their prescribed dose, or fail to follow directions on the timing of their dose, may encounter next-day drowsiness as a problem.

In either case, patient education is critical. Doctors who prescribe these sleep medications must be thorough in educating their patients on the proper use of these powerful drugs. And patients must listen to—and follow through with—their doctors’ instructions.  

I do have concerns about the response that may follow these new lower-dosage recommendations. In my experience in clinical practice, the 10-milligram dose of zolpidem is usually the most effective dose for treating insomnia. I worry that patients who are moved to a lower dosage will simply take twice as much of their medication, in an attempt to reach the desired effect of their previously higher dose. Again, compliance is a critical issue: if you are a patient taking this type of sleep medication, it’s important that you follow your prescribing physician’s instructions, including sticking to the right dose.

It’s also important to keep in mind that there are low-cost, effective, non-chemical alternatives to prescription sleep medication. Drug therapy for sleep is just one option for treatment, and in some cases it will be the best option. But don’t overlook these alternatives:

Cognitive-Behavioral Therapy (CBT): I’ve written before about the power of CBT in improving sleep. Studies show that CBT can be as effective or even more effective than drug therapy. And this type of therapy doesn’t always have to be an extended, long-term endeavor: research shows that targeted, short-term behavioral therapy can improve sleep for people with insomnia.

Meditation and Relaxation: Mind-body therapies such as meditation and relaxation can also help to improve sleep, and diminish symptoms of insomnia and other sleep disorders. Relaxation techniques such as deep breathing exercises, muscle relaxation, and visualization techniques are recommended treatments for sleep by the American Academy of Sleep Medicine. This is a growing area of sleep research, which shows promise in treating sleep disorders such as insomnia and restless leg syndrome.

Sleep Restriction: This is a behavioral therapy that limits time spent in bed as a way to improve sleep. Rather than tossing and turning in bed, feeling frustrated and anxious at not falling asleep, get out of bed. Find a quiet place to relax (not in front of the television), until you feel ready to go back to bed and sleep. Sleep restriction also involves keeping regular morning wake times, and not staying in bed longer in the morning in order to make up for sleep lost at night. 

Hearing reports such as these can be unsettling. But making abrupt changes to your prescription sleep medication is not a good idea. If you’re taking a zolpidem sleep medication, you should continue to take your regular dose until your prescribing physician makes a change. Do not make a change to your dose on your own. Talk with your doctor and follow his or her recommendation.

 

Sweet Dreams,

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

Something New in Melatonin?

You don’t have to be a shift worker or jet setter to have awkward or non-existent sleeping habits, but both groups suffer quite a bit. Melatonin, one of the more popular over-the-counter supplements, may be headed toward a new delivery system, a patch placed on the body with small pulses of the hormone administered throughout the evening (or day), through your skin!

I’ve written about this sleep aid frequently because I get so many questions on it.  Many supplement companies and health food stores will claim that melatonin is a natural sleeping aid or nightcap because it “naturally” helps regulate sleep-wake cycles. Given its wide spread availability today, you’d presume it’s safe and effective.

Is it?

Make Money in Your Sleep

Now this is pretty funny. Depending on how you look at it.

Earlier this month Steve Martin appeared on David Letterman talking about his experience with a sleep aid (you can go here to view the actual clip). An avid online poker fan, Mr. Martin found himself playing late one night, going to sleep after taking a sleep aid, and then waking the next morning to find new winnings in his online poker account. He’d gone to bed with $500 in his account and discovered that the same account was worth $1,500 the next day.

He thought there had been a glitch in the system. He thought there had been a mistake. But no, there wasn’t a glitch or a mistake. When Mr. Martin called to check with the people behind the online poker game, he was told that he’d in fact won that extra $1,000 while playing between 4 am and 5 am.

Needless to say, Mr. Martin had no recollection of getting up, getting online, and playing poker in the middle of his sleep. The experienced freaked him out enough that he stopped using the sleep aid.

Is this the norm?

Far from it. Sleep aids are some of the most widely prescribed medications in America, and it’s rare to have such a bizarre reaction to these drugs. Reports have emerged about strange side-effects like sleepwalking, sleep talking, driving, eating, and performing tasks while supposedly in your sleep. But again, these side-effects are extremely rare.

It’s not known whether Steve Martin’s mid-sleep poker playing (and win) was related to his taking a sleep aid. But his experience marks the first time someone has come out and blamed a sleep aid on winning money from playing poker during sleep.

This gives new meaning to “making money in your sleep,” doesn’t it? Good thing he posted winnings that night. What if he’d gone online and unknowingly blown away thousands of dollars? He’d probably call his lawyer.

Sweet Dreams,

The Sleep Doctor
Michael J. Breus, PhD

Click here to see Dr. Breus's list of recommended sleep products. 

Hope for Jet Setters and Shift Workers

Nothing is more frustrating than needing to be and feel awake and alert, but you just can’t for whatever reason. Although life is usually very busy for those who have regular 9 to 5 jobs and families to run, it’s quite different for people whose jobs have them covering odd shifts or traversing the country through different time zones and long journeys (ahem business travelers).

I admire the people who can continue to live “like that”—working when most of the world is sleeping or working mostly from the road or an airport. It’s very difficult not only to sleep well (and regularly), but also to eat well and find a routine that jibes with your family life, too.

And there are more people who fall under this category than you might think: According to U.S. labor statistics, about 20 percent of the workforce or about 19.7 million U.S. workers are early risers who begin work between 2:30 a.m. and 7 a.m.m.

That kind of timing can throw any body rhythm out of whack—a rhythm that’s essential to feeling sleepy or awake at the right time. Let’s not forget about others like traveling athletic teams, tourists, and experts in their field who are called to speak, consult, and interview across the country. Back when I was rigorously promoting my book, my schedule fit the bill! I’m thankful I don’t have to do that 365 days a year, so I’m sympathetic to those who do.

Which is why I was happy to read about a new study this week that offers hope for the lagging jet-setters and people dedicated to irregular job hours. Turns out that an insomnia drug that helps the body produce more melatonin, the sleep hormone that starts pumping when night falls to signal your body that it’s time to go to sleep, may improve Zs for jet-lagged travelers and shift workers. The drug is called tasimelteon, or VEC-162, and it’s just been shown to help people sleep longer and more deeply than a placebo.  

So why not just take melatonin as a supplement instead? Given the availability of this supplement today, you’d presume it’s safe and effective.

It’s true that melatonin is a hormone your body produces to help it regulate your sleep-wake cycles, but taking additional melatonin in the form of a supplement can be difficult. It’s not a regulated drug under the FDA, so without knowing your source, it could be trouble.

Having to take a drug at all to maximize sleep quality isn’t ideal, but in many cases it’s better than the alternative. If only the entire world could keep operating if everyone slept at night and work and played during the day. Maybe the cavemen—who didn’t live in a global  24/7 society—really did have it better. 

Can You OD on Sleeping Pills?

The news of actor Heath Ledger's death this past week is an incredibly sad story, especially given the news that he had a troubled sleep life and seemingly fought hard to overcome his problems. When the news reported that the sleeping pill Lunesta was found in his apartment, my hope was that people didn’t automatically assume he yanked the rug out from under himself by downing a litany of Lunesta. Apparently, other meds were in the mix, and it will take time for the toxicology report to (hopefully) pinpoint exactly what took his life.

I hear echoes of the Anna Nicole Smith case, who died last year of “combined drug intoxication” with the sleeping medication chloral hydrate, which was found in her system, being the “major component.” (No illegal drugs were found in her body.) Chloral hydrate is of the old-fashioned kind of sleeping pills; it’s a strong sedative—the same one speculated to be responsible (potentially) for Marilyn Monroe’s premature death. Granted, I don’t think it was ever determined exactly what killed Marilyn.

With today’s new class of sleeping pills it’s highly unlikely that you can overdose to the point that you kill yourself (there is one paper showing someone took 180 10mg tabs of Ambien and woke up 4 days later, no problems).

Wake Up and Smell the Sugar Pill—or Don’t and Let It Work!

Millions of people have used Benedryl to lull themselves to sleep. The medication, whose main ingredient is the antihistamine Diphenhydramine, has long been reported to help people fall asleep. Well, here’s a little secret that millions probably don’t realize: it works by virtue of its placebo effect. That’s right: it’s all in your head so to speak.

I got a little riled up the other day when I read a posting online at the Consumerist about the fact 48 percent of doctors admit to prescribing placebos just to “shut you up.”  The University of Chicago came out with that figure, and the original article appeared in the Chicago Sun-Times. (Just then, I pictured a screaming mad patient with the common cold, which is caused by a virus, begging the doctor to write a prescription for antibiotics.)  Placebos, according to the article, included “vitamins, herbal supplements, saline infusions, dummy pills and doses of medicine too low to be effective.”

Well, as was the case for the man outraged at getting a placebo, he went in to his doctor’s office complaining of poor sleep and walked out with a prescription for the over-the-counter med Benedryl. (He didn’t, however, share with the doctor that he’d tried Benedryl in the past to no avail. He didn’t realize his prescription was actually for Benedryl until the pharmacist pointed in out.)

Listen up, folks: Benadryl, at least in my circle, is a placebo.

The guy is right in his frustrations. But the comments other people made back at him are wrong! (If you go to the site, you’ll find lots of people barking back telling the man that Benedryl is a mild sedative and is found in sleep aids.) I’m tempted to join the foray and dispel all the garbage people are posting now in defense of the Benedryl prescription. Take note: There is absolutely no clinical data to suggest that Benedryl or its active ingredients will have you fall asleep or stay asleep any longer than a sugar pill.  And to add insult to injury, the half life of this medication means you could wake up feeling a big “hung over,” as it has similar effects to alcohol.

The lesson? If Benedryl helps you fall asleep, stick to your story (for the placebo effect!) but don’t make it a habit and use it all the time. Go for establishing better sleep habits and speak openly with your doctor about things you’ve tried for better sleep. You may have a bond fide sleep disorder for which the bedtime bath and Benedryl won’t work. Period.

Sleep Aids and Severe Side Effects

There was an interesting article about Lunesta up the other day on The Examining Room of Doctor Charles.

Says drcharles:

I received a letter today from Sepracor, the manufacturers of Lunesta, a popular sleep aid indicated for the treatment of insomnia. Many doctors are hesitant to prescribe sleep aids, partly because of their often habit-forming nature and potential side effects. Sepracor's letter discussed labeling changes approved by the FDA. The new labeling will include warnings about severe allergic reactions that may occur during sleep, and sleep-driving or other complex behaviors (e.g. preparing and eating food, making phone calls, or having sex) with associated amnesia for the event.

From an FDA press release a few weeks old:

Although all sedative-hypnotic products have these risks, there may be differences among products in how often they occur. For this reason, FDA has recommended that the drug manufacturers conduct clinical studies to investigate the frequency with which sleep-driving and other complex behaviors occur in association with individual drug products.

The medications that are the focus of the revised labeling include the following 13 products:

    Ambien/Ambien CR (Sanofi Aventis)
    Butisol Sodium (Medpointe Pharm HLC)
    Carbrital (Parke-Davis)
    Dalmane (Valeant Pharm)
    Doral (Questcor Pharms)
    Halcion (Pharmacia & Upjohn)
    Lunesta (Sepracor)
    Placidyl (Abbott)
    Prosom (Abbott)
    Restoril (Tyco Healthcare)
    Rozerem (Takeda)
    Seconal (Lilly)
    Sonata (King Pharmaceuticals)

Dr. Charles is right to point out that severe reactions to these medications are rare; but even so, it does make you take pause and wonder if non-pharmacologic alternatives are the better way to go, whenever possible.

If you're interested in learning more on this subject, you can listen to the Health Hacks podcast interview I recently recorded. I do talk in that podcast about cases I've seen.

Ambien's Patent is Up; Could Sleep Drug Costs Be Going Down?

Guess what?   The time has actually come for the patent of one of the most widely used sleep medications in the world -- Ambien -- to come to an end.   According to a recent article in The Sleep Report:

This year alone, 10 brand-name medications with revenue exceeding $8.1 billion are expected to lose patent exclusivity, including the widely prescribed sleep medication Ambien (zolpidem tartrate).

• Ambien’s US sales exceeded $2 billion last year.
• Medications to treat sleep disorders are one of the fastest growing categories of drug spending, rising 31.5% in 2005 alone according to Medco Health Solutions Inc, a pharmacy benefit manager.
• While seniors use the most hypnotics, younger adults showed the greatest increase in use of these drugs.
• According to Medco’s analysis, the number of adults aged 20 to 44 years using sleeping medications increased by 128% between 2000 and 2005.
• According to pharmacy market analyst IMS Health, a one percent increase in generic utilization nationwide yields almost $4 billion in savings.

So what does this mean for those of you who are taking these valuable medications?

First, you should know that the makers of Ambien have done a great job of reducing the price of their newest medication, Ambien CR, so that it will match or come very close to the price of generic.

Next, I hope to see insurance companies recognizing that the use of these medications can in fact LOWER our healthcare premiums, but I doubt it.