Lost jobs and lost careers. Promising businesses in shambles. The college acceptance letter returned to its envelope. This is how President Obama recently described the effect of the tanking economy on ordinary Americans -- and the stresses keeping them up at night.
Sleeplessness is a problem even in good times. One in 10 U.S. adults routinely has trouble getting to sleep or staying asleep, and 3 in 10 experience occasional sleeplessness, federal statistics show.
For The Record
Los Angeles Times Saturday, April 04, 2009 Home Edition Main News Part A Page 4 National Desk 2 inches; 80 words Type of Material: Correction
Sleeping pills: An article on insomnia in Monday's Health section stated that Gregg D. Jacobs, an insomnia specialist at the University of Massachusetts Medical Center in Worcester, has a company that markets a drug-free insomnia treatment program. Although Jacobs has a website on which a treatment program is sold, he doesn't own a company, nor does he market or advertise the program. Also, the article shouldn't have referred to Jacobs as "Dr." He has a PhD, not a medical degree.
For The Record
Los Angeles Times Monday, April 06, 2009 Home Edition Health Part E Page 4 Features Desk 2 inches; 79 words Type of Material: Correction
Sleeping pills: A March 30 article on insomnia incorrectly stated that Gregg D. Jacobs, an insomnia specialist at the University of Massachusetts Medical Center in Worcester, has a company that markets a drug-free insomnia treatment program. Although Jacobs has a website on which a treatment program is sold, he doesn't own a company, nor does he market or advertise the program. The article also shouldn't have referred to Jacobs as "Dr." He has a PhD, not a medical degree.
But these are definitely not good times. More than 1 in 4 -- 27% of Americans -- say anxieties about personal finances, the economy or a job loss kept them awake in the previous month, according to a new poll by the National Sleep Foundation.
If that isn't enough evidence of our increasingly sleep-deprived state, consider this: Since September, audiences of such after-prime-time network shows as "Late Night With Conan O'Brien" have risen. No wonder the collective experience of "sleepless nights" found its way into a presidential address.
As Americans struggle for a good night's rest, they are looking for help from a pill. Prescriptions for sleeping medications topped 56 million in 2008 -- a record, according to the research firm IMS Health, up 54% from 2004.
Those numbers could grow. With an economic turnaround not expected before late 2009, some specialists are predicting another record year for sleeping pill use.
"The first stress symptom people experience is insomnia," said Dr. Gregg D. Jacobs, an insomnia specialist at the University of Massachusetts Medical Center in Worcester. "The size of the sleeping pill market can only go up because of the economy and stress."
But sleep medications are not without risk: next-day drowsiness is the most common among a list of adverse reactions that include dependence and memory loss. As more people take the drugs, the number of people experiencing problems is likely to rise.
For those reasons, some sleep disorder experts say, it may be time we learned to fall asleep on our own.
Effects on the brain
Sleep is a complex physiological process connected to such environmental factors as light and temperature. As night falls and temperatures drop, chemicals in the brain begin to slow the activity of neurons responsible for attention and wakefulness -- and drowsiness sets in.
The two largest classes of sleeping pills enhance the activity of one of these brain chemicals, a neurotransmitter called gamma-aminobutyric acid, or GABA. This neurotransmitter is an imperfect drug target because it performs multiple functions in the brain. Depending on the receptors involved, GABA may promote sleep, decrease anxiety or relax muscles.
Benzodiazepines, an older class of sleep medicines that includes Valium, enhance the broad range of the neurotransmitter's effects -- one reason why benzodiazepines are also used to treat panic attacks. But benzodiazepines lost their popularity as sleep medications in the 1990s after reports of side effects, including drug dependence. England removed the sleeping pill Halcion from the market in 1991 because the medication was associated with depression and memory loss. Although Halcion is still available by prescription in the U.S., it carries a strong warning.
The newer GABA-enhancing pills are known as the Z drugs, so-called because the drugs have the letter "z" in their generic names. Now the most popular prescription sleep medications, the class includes Ambien (zolpidem), Sonata (zaleplon) and Lunesta (eszopiclone). Ambien and Sonata act on the receptor connected to sleep more selectively than other GABA-enhancing drugs The Z drugs carry a smaller risk of dependence than benzodiazepines, a key reason for their popularity. However, the U.S. Drug Enforcement Administration classifies both the benzodiazepines and the Z drugs as scheduled drugs, meaning they all have some risk of dependence.
Another of the newer pills, Rozerem (ramelteon), does not target GABA. It acts on the melatonin receptors in the brain, which are thought to help regulate sleep-wake cycles. It is the only prescription sleeping pill that does not carry a risk of dependence. But doctors tend to think it is not as effective as competing pills.
The perceived safety advantages of the newer drugs over the benzodiazepines -- and aggressive consumer advertising -- have spurred prescription growth.
During 2007 and 2006, drug manufacturers Sanofi-Aventis (the maker of Ambien), Sepracor (maker of Lunesta) and Takada (maker of Rozerem) spent an average of $11.8 million a week to advertise sleep medications, according to the market research firm TNS Media Intelligence. Total prescriptions for sleep medications increased 10% and 15% respectively in those years, according to IMS Health.
Drug makers have since slashed ad spending in response to competition from lower-cost, generic versions of Ambien, 50% in 2008 alone, but the demand for sleep help continues to rise. Those cheaper pills are now driving most of the prescription growth.