Sleeping-Pill Puzzler

By Christine Gorman

Every once in a while, a story about a bizarre pharmaceutical side effect races through the media like a brush fire on a dry, windy day. This time the blaze is coming from the hot-selling sleeping pill called Ambien and its apparent ability to compel some users to eat voraciously in their sleep. Never mind the fact that this particular side effect is seemingly rare--or that it was first reported four years ago. Thousands of sleep-deprived Americans are now wondering if Ambien could turn them into mega-munching zombies.

The news, such as it is, is that researchers at a Minnesota sleep-disorders center are going to publish a paper in which they have identified a few dozen people who, after taking Ambien, developed uncontrollable urges to eat while they were asleep and didn't remember their feeding binges when they woke up. Meanwhile, in the popular press, there are sporadic accounts of folks driving their cars while under the influence of Ambien and even some claims of sleepwalking that turned into sleep driving.

This is a situation in which it's good to have an internist like Dr. Donna Sweet of Wichita, Kans., for a physician. "We're talking about a study with 32 people," says Sweet, who also chairs the board of the American College of Physicians. "I tell my patients, 'If you've done well on Ambien in the past, you'll continue to do well on Ambien. You're not going to suddenly start eating in your sleep.'"

That view is echoed by Dr. Michael Silber of the Mayo Clinic in Rochester, Minn. "It's certainly a minority of Ambien patients who develop problems with sleep eating," says Silber, who first described the effect in a 2002 research article in the journal Sleep Medicine. It generally disappears after the patients stop taking Ambien and--significantly--can also occur in folks who don't take Ambien.

As for sleep driving (as opposed to driving under the influence), Silber, who has been doing sleep research for 15 years, has never personally seen a case, either in Ambien users or nonusers. "Not that it doesn't happen, but sleep driving is very, very rare," Silber says. By contrast, he says, sleepwalking probably affects 1% to 2% of the population.

Like many other doctors, Silber and Sweet believe all sleeping pills are overprescribed and note that physicians may be giving their patients the heavily marketed drugs they ask for in order to focus what's left of their increasingly abbreviated office visit on more serious complaints.

So if you're having trouble sleeping, start by figuring out if your sleep habits need improving. Move the television out of the bedroom. Try going to sleep and waking up at the same hours every day, including weekends. Cut back on spicy foods and chocolate if you find yourself waking up with heartburn. Limit your intake of caffeine, which makes it more difficult to fall asleep, and alcohol, which causes a rebound effect that can wake you up. Practice meditation or other stress-reduction techniques. If none of those work, you can talk to your doctor about whether prescription sleeping pills make sense. But remember, they really are best suited for short-term use.