Side effects have bedeviled prescription sleep medications since scientists began tinkering in their labs more than a century ago.
Chloral hydrate, a derivative of ethyl alcohol, was first introduced in 1869 as a sedative-hypnotic. It was the primary ingredient of so-called knockout drops, which did what the nickname suggests: They knocked people unconscious, making them popular with criminals. But besides the side effect of parting you from your money, chloral hydrate could also put you in a stupor — and even kill you in five to 10 hours.
The first generation of modern sleeping pills, barbiturates, hit the U.S. market in the early 1900s. They had their own serious consequences, two of which were addiction and overdosing. Next came the benzodiazepines, known by the brand names Valium, Halcion, Dalmane, Ativan, Xanax and Klonopin. They are largely prescribed for anti-anxiety, but their sleepy side effects have made them America’s favorite prescription sleeping pill.
But easy benzo sleep comes at a price. Besides being highly addictive, a recent study linked benzos with Alzheimer’s.
We’re now on our third generation of sleep aids, all of which still come with side effects and warnings in their packaging material. But that shouldn’t surprised anyone — sleeping pills work by sedating your central nervous system in one way or another. They may inhibit or block neurotransmitters, slow down breathing, and trick your tired body into sleep.
What are some risks of the newer sleep meds?
The newest class of sleep medications, non-benzodiazepines, also called Z-drugs, can help alleviate insomnia with fewer side effects than their benzo predecessors. But they still have them. Known by their brand names Ambien, Ambien CR, Lunesta, Sonata and Rozerem, they’re considered safer. But they’re still recommended for short term use; they, too, too can become addictive.
Here are their side effects, by brand:
Serious (though rare) side effects (requires a call your doctor):
Chest pain, fast or irregular heartbeat, shortness of breath, trouble breathing or swallowing, feeling like you might pass out.
Severe allergic reactions (stop taking pills and get immediate emergency medical help): hives, difficulty breathing, swelling of face, lips, tongue or throat.
The most notorious side effects of Ambien were reports of patients engaging in bizarre behaviors like driving, making phone calls, having sex or gorging on candy bars — while more or less asleep — then having no memory of their activities the next day. These cases are rare (about one percent of patients), but noteworthy.
Equally rare, but still disconcerting are the one percent of patients who have suicidal thoughts, or an uptick in aggressive behavior. This is a particular risk if the patient is depressed. The FDA recently recommended lowering the dosage from 10 milligrams (mg) to five mg, especially for women, whose bodies eliminate the active ingredient, zolpidem, more slowly than men.
Ambien CR (zolpidem tartrate)
This longer-acting Ambien releases zolpidem into your bloodstream continuously throughout the night; it was designed to help people stay asleep.
Most common side effects: headaches, sleepiness, dizziness, next-day drowsiness
Serious side effects (requires a call your doctor): getting out of bed and doing an activity you don’t know you’re doing, abnormal thoughts and behaviors (aggression, agitation), memory loss, anxiety.
Severe allergic reactions (get immediate emergency medical attention): swelling of the tongue or throat, trouble breathing, nausea and vomiting.
First off, this medication may not work well if taken with high-fat foods.
Possible side effects: headache, pain, daytime drowsiness, lightheadedness, dizziness, loss of coordination, nausea, vomiting, heartburn, unpleasant taste, dry mouth, unusual dreams, decreased sexual desire, breast enlargement in males.
Serious side effects (requires a call to your doctor): not thinking clearly, engaging in activities while asleep, abnormal behaviors such as aggression, hallucinations, agitation, confusion.
Severe allergic reactions (get immediate emergency medical attention): hives; rash; itching; swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles or lower legs; difficulty breathing or swallowing; feeling like your throat is closing; hoarseness.
This is a short-acting sleep drug that helps patients fall asleep.
Common side effects: next-day drowsiness, lightheadedness, dizziness, pins and needles on the skin’s surface, difficulty with coordination.
Serious side effects (requires a call your doctor): doing an activity you’re not aware of doing while not fully awake, abnormal thoughts and behaviors (confusion, agitation, hallucinations, worsening of depression), memory loss, anxiety.
Severe and allergic reactions (get immediate emergency medical attention): suicidal thoughts or actions, swelling of the tongue or throat, difficulty breathing, nausea and vomiting.
This newest sleep drug is part of a class of medications called melatonin receptor agonists. It works similarly to melatonin, with the body, and promotes sleep rather than sedation, meaning it doesn’t depress the central nervous system.
Common side effects: dizziness, drowsiness
Serious side effects (requires a call to your doctor): decreased sexual desire, milky discharge from the nipples, irregular or missed menstrual periods, vomiting, nausea
Serious allergic reactions (get immediate emergency medical attention): swelling of the tongue or throat, difficulty swallowing or breathing, feeling that the throat is closing.
Morning grogginess and lower alertness may seem like the least worrisome of all sleep medicine side effects — prescription or otherwise. But this becomes a public health hazard if you drive a car, pilot a plane or operate some other type of transportation or heavy machinery.
As always, make sure your doctor knows about your daily life and how any medication can affect it.