There are some scary stories out there about sleeping pills. We wanted to separate fact from fiction. So we talked with sleep specialist Jim Krainson, M.D., medical director of the South Florida Sleep Diagnostic Center in Miami and spokesperson for the American Academy of Sleep Medicine. Here are the facts about sleeping pills, as he sees them.
How to Take Prescription Sleeping Pills Safely
Q. Are prescription sleeping pills dangerous?
JK: If you have a sleep medicine prescribed by a doctor who does not know all your medications, who has not given you the warnings about combining sleep medicines with other medicines; if you have not been given instructions as to how many you can take and not to take extra; if you haven’t been given instructions about warnings about possibility of falls and things like that with sleep medicine; if you haven’t been evaluated—at least history of your current sleep patterns—then I would be very concerned about the sleep medicines.
I mean, all these things should be taken into account before sleep medicines are given. There are some very dangerous conditions which some sleep medicines can make worse.
Q. What conditions can sleeping pills make worse?
JK: One of the conditions is sleep apnea, and that’s where a person actually blocks off their airway at night. And many sleep medicines—again not all—many sleep medicines will actually make your muscles relax so much that it can actually contribute to that and can contribute to respiratory depression, and that can be dangerous.
So the doctor should be asking you if you snore at night, should be concerned if you’re overweight, if you have a large neck size, if you have a thick tongue, if you ever wake up with choking sensations—things like that—before prescribing sleep medicines.
Q. If your doctor has done all these things, are prescription sleeping pills safe?
JK: If your doctor has prescribed your sleep medicine, and if he’s done all the good things, then I would not be overly concerned. He probably prescribed them thinking that you would tolerate them well and gave you good instructions.
Anything short of that, I would go back to your doctor and ask them about, “Am I at risk for taking sleep medicines? Do I have any underlying conditions? Can you determine if I have sleep apnea?”
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Q. Are there any dangerous medication interactions people should be aware of?
JK: Sure. Any other sedative is going to compound or increase their effect. ... And certainly alcohol.
What to Do If Your Prescription Sleeping Pill Doesn't Work
Q. If your sleeping pill isn’t working, should you try taking one more pill?
JK: No no. Unless you’re—unless it’s been specifically prescribed to take extra ones by your doctor, if you’re not falling asleep in a short period of time—about 15, 20 minutes—you should probably get up out of bed and go do something that’s not stimulating until you feel tired .... And then go back to bed and try and go back to sleep.
Most patients with insomnia—either the difficulty falling asleep or difficulty maintaining your sleep—most can be treated without sleep medicines. And there’s been studies that compare sleep medicines to behavioral therapy—you know, simple sleep-hygiene measures—where behavioral therapy has come out as good if not better in many cases than the medications. And certainly it’s safer.
Q. What if you take just a couple extra sleeping pills? Is that going to kill you?
JK: You shouldn’t take even one extra unless the doctor tells you. And there are some pills that do allow you to take an extra pill if you still have four hours of sleep available at night. But most of them, if you’re taking an extra one later in the night, you’re going to be sleeping into the daytime, and that’s not going to be good. That breaks the sleep hygiene rule of getting up at the same time every day. So you don’t want that. And you certainly don’t want to be awake and under the influence of sleeping pills. Then your functioning during the daytime—your driving—all that can be impaired.
Q. So if you take an extra sleeping pill, the main risk is that you’d be sleepy and impaired during the day?
JK: Or that you die or something terrible …
Q. Oh, so just one extra prescription sleeping pill could kill you?
JK: Well, it depends on the person. Sometimes one is too many for some people who have certain disorders. So some people shouldn’t take any sleeping pills. So if some people shouldn’t take any sleeping pills, I don’t think we can ever say that an extra one is going to be safe.
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Last updated and/or approved: March 2011. Original article appeared in January 2008 former print magazine. Bio current as of that issue. This general health-care information is not meant as individual advice. Please see our disclaimer.