Getting Some Sleep: With or Without a Pill?

When insomnia strikes, it might be tempting to pop a sleeping pill. But that remedy seems more risky in the wake of last year’s reports that Halcion (triazolam), the world’s most-prescribed sleeping pill, can cause temporary memory loss. A federal advisory panel studying those reports of side effects stopped short of banning the drug, citing no evidence that the pill endangered public health.

Now, the manufacturer of a new sleeping pill called Doral (quazepam) promises the same relief as Halcion but without the side effects.

Here, Martin Scharf, a Cincinnati sleep researcher who studied Doral during a 35-day manufacturer-funded study, talks about its benefits. Los Angeles sleep researcher Michael Stevenson talks about natural remedies to combat insomnia, which plagues about 30 million Americans.

Martin Scharf, director of the Center for Research in Sleep Disorders at the Mercy Hospital, Cincinnati

“Doral is the first long-acting hypnotic to come on the market in several years. It is a benzodiazepine, the same class of drugs as Halcion. But it has two advantages. It binds to a specific subtype of benzodiazepine receptor believed to be involved only in the regulation of sleep (not muscle relaxation or anti-anxiety effects).

“That may account for our finding that Doral use had no effect on daytime performance. The drug stays in the body longer than Halcion, which is another advantage.

“After a while, we can put people on alternate-night therapy, in which they take the medicine every other night. So patients are taking less medicine less frequently. Our goal is to get them to a pill-free state.

“We compared alternate-day Doral therapy with alternate-day Halcion therapy. Taking Halcion every other night worsened sleep problems on the non-drug nights. But taking Doral every other night improved sleep on the non-drug nights as well as the drug nights.

“Like any sleeping pill, Doral is not meant to be taken for a long period of time.”

Michael Stevenson, clinical director, North Valley Sleep Disorders Center, Mission Hills

“Transient intermittent insomnia is nothing to be concerned about. But you don’t want to turn it into a chronic problem. To avoid that, develop a pleasant and relaxing bedtime ritual. Start on your relaxation routine an hour or so before bedtime so you can wind down. Do not discuss finances, politics or problems with the kids. Do some sort of relaxation ritual--meditate, do progressive muscular relaxation or use imagery. Drink warm milk or eat a complex carbohydrate snack like low-sugar cereal. Avoid snacks like cake or candy. Use the bedroom only for sleep and sex.

“What if you develop insomnia despite all this? If you can’t sleep, don’t toss and turn longer than 20 minutes. Get up and do something relaxing.”