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New Sleeping Pills Are Effective, But None Stands
Out as the Best
Study of Lunesta, Ambien, Imovane and Sonata and
found no winner
By Becky Ham, Science Writer
Health Behavior News Service
Dec. 16, 2005 - The spate of new sleeping pills on
the market are effective treatments for insomnia, but they have
different effects and no one drug stands out as the best, according to a
new review of studies on drugs including Sonata, Ambien and Lunesta.
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Reviewers from the Oregon Evidence-based Practice
Center at the Oregon Health and Science University concluded that the
drugs were better than placebo pills at treating insomnia symptoms such
as trouble falling asleep and staying asleep.
There were few head-to-head comparisons of the
drugs, however, and although there are some differences between the
drugs on some outcomes, no one drug appeared to be consistently
superior, say the Oregon reviewers, led by Susan Carson, M.P.H.
The Oregon Evidence-based Practice Center makes
available information regarding the comparative effectiveness and safety
profiles of different drugs within pharmaceutical classes.
The review included 141 studies of Sonata, Ambien,
Lunesta and Imovane, a Canadian brand. The medicines are considered
newer sleep aids and have been on the market since 1992. The drugs are
commonly prescribed for insomnia in place of older sedatives such as
benzodiazepines (marketed under brands such as Halcion, ProSom and
Restoril).
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"... senior citizens ages 65 and
older are still the largest users of prescription sleeping pills."
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Benzodiazepines work through the same brain
receptors as the newer drugs and are also effective sleep aids, but
researchers believe that the newer drugs are less likely to lose their
effectiveness or lead to abuse over time.
In the seven head-to-head studies of the newer
drugs identified by Carson and colleagues, the researchers uncovered
some differences. In the four studies comparing Sonata to Ambien, for
example, Sonata was better than Ambien at putting people to sleep
quickly, while patients on Ambien slept longer and reported having a
better quality sleep than those taking Sonata.
Although there are some differences among the
drugs on the different outcomes, it does not follow that one drug would
necessarily be more or less effective for patients with one type of
insomnia over another, Carson said. We found no studies comparing the
different drugs in patients with different insomnia complaints, so we do
not know for sure that one drug would work better in one patient over
another.
Short-term side effects such as headaches and
daytime sleepiness occurred at similar rates with the drugs, the
reviewers found.
The reviewers found few studies that looked
specifically at the drugs performance in groups such as older adults
and pregnant women or that compared effects between racial groups or men
and women.
One study of older women found that those taking
Ambien were more likely to suffer hip fractures than those taking no
sleep aids, but Carson cautioned that the study could not tell whether
other factors may have led to broken hips.
Additionally, no studies like this have been
conducted with the other drugs, so we cant say if the other newer
sedative hypnotics would have a similar effect or not, she said.
The Oregon reviewers also compared the newer drugs
to benzodiazepines. Most of these comparisons found that the newer drugs
were as effective as benzodiazepines, with similar side effects.
Carson and colleagues say there are no comparative
studies that track the long-term effectiveness and safety of the new
sleep aids, although there have been some reports of patients becoming
dependent on Ambien and Imovane.
Studies that look at long-term serious events such
as bone fractures, abuse and withdrawal symptoms are needed, Carson
says, noting that the longest placebo-controlled study of these drugs is
only six months long.
Most of these drugs are not approved for
longer-term use, because the studies have not been conducted, but in
practice patients may take them for a longer period than the recommended
seven to 10 days. So studies that mirror the ways the drugs are actually
used would be very helpful, Carson said.
The National Institutes of Health estimates that
more than 70 million Americans have trouble sleeping, with the
likelihood of insomnia increasing with age.
An October 2005 study conducted by Medco Health
Solutions, a managed care company, found that American senior citizens ages 65 and
older are still the largest users of prescription sleeping pills.
Sleeping pill use among adults 20 to 44 years old has doubled in the
past four years, spending on them has increased by 190 percent and drug
companies spent $2.1 billion advertising them in 2004. The number of
sleep aid prescriptions for children and younger adults ages 10 to 19
jumped 85 percent between 2000 and 2004, the Medco researchers found.
About source:
Carson S, Yen P-Y, McDonagh MS: Drug class review
on newer sedative hypnotics. Oregon Evidence-based Practice Center, Dec
2005
Reports released by the Oregon Evidence-based
Practice Center are not usage guidelines, nor should they be read as an
endorsement of, or recommendation for, any particular drug, use or
approach. Oregon Health & Science University does not recommend or
endorse any guideline or recommendation developed by users of this
report.
Health Behavior News Service: (202) 387-2829 or
www.hbns.org.
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