Sleeping Pills: Too Risky, or a Red-State, Blue-State Affair?

How do people with insomnia feel about sleeping pills?

Attitudes toward sleep medications differ from one American to the next, and between Americans and Australians, it turns out. Here’s a brief comparison that I hope will start a conversation.

Sleeping pills are viewed differently in Australia and the US

Sleeping pills are viewed differently in Australia and the USHow do people with insomnia feel about sleeping pills?

Among 51 insomnia sufferers interviewed by Australian researchers in Sydney, both users and non-users of sleeping pills (or sleeping tablets) held negative views of sleep medications.

When I asked this same question of the 90-odd American insomniacs I interviewed for my book, the response was more divided. Some people viewed prescription sleeping pills as harmful and said they’d never use them. Others felt their sleep medications were helpful and would not want to give them up. Here’s what I wrote:

Poll the sleepless about sleeping pills, and you come up with . . . a red-state, blue-state affair. In one camp are the pill abstainers . . . and in the other, insomniacs who’d sooner dump their iPhones than part with their pills.

Pro or con, attitudes about sleeping pills are often strongly held. Following is a brief comparison of Australian and American attitudes that I hope will start a conversation.

Safety vs. Effectiveness

Both the Australians and the Americans felt that pharmaceutical sleep aids were stronger and more effective at putting people to sleep than over-the-counter (OTC) sleep aids or “natural” sleep aids such as valerian or melatonin.

But most Australians said they didn’t like taking sleep medication. They expressed a definite preference for natural products based on the notion that natural products were gentler on the body and had fewer harmful effects. In the majority view, safety concerns outweighed concerns about sleeping tablets’ effectiveness.

“I’ll take something that isn’t as effective so it doesn’t have any negative consequences,” said a man quoted in the Australian study.

A woman, comparing how she felt about taking the sleeping pill temazepam (Restoril) with how she felt about about the prospect of taking melatonin, said this: “I felt it’s a more natural remedy than the temazepam. So I think I was less stressed about taking it.”

But the Australians were divided as to whether prescription or OTC medication was the safer option. Some thought OTC sleep aids (medications containing diphenhydramine, such as Benadryl and Tylenol PM in the United States) were safer because they were available without a prescription and therefore less potent and apt to have fewer side effects. Others felt the safer alternative was to go with a prescription medication recommended by a doctor who was familiar with one’s individual medical needs and could supervise the process.

Among Americans, a Split

About half of the insomniacs I interviewed felt they needed medication to get a good night’s sleep and were mainly concerned about medications’ effectiveness. Jane M. wrote the following comment on one of my earlier blogs. It epitomizes the feelings of insomniacs who were satisfied with the sleeping pills they were using, having decided the benefits outweighed concern about risks.

“I was first prescribed Ambien many years ago, and don’t think I could have continued my work life this long without it. I sleep soundly eight hours every night, wake up with lots of energy, and have always wanted to meet the discoverer of the formula to thank him or her.

“My gratitude is deeply felt. My mother, who died in 1983, sat up half the night for years. I think there are genetic issues, hormone issues, aging issues . . . I could walk 20 miles a day and I still wouldn’t be able to fall asleep. Some people have asked, ‘What if you become addicted?’ to which my answer has always been ‘So what?’ I am addicted to sleep, good health, and a strong work ethic. Ambien has made it all possible for me into my mid-70s.”

Some Americans Concerned About Risks

The other half of my respondents voiced reservations about sleeping pills, similar to the Australians. Their reasons were mixed. Some did not think of insomnia as a medical problem, preferring to address it through changes in lifestyle or psychotherapy rather than with drugs.

Other insomniacs shied away from using sleeping pills because of negative feelings about medication overall and about prescription hypnotics in particular. Still others felt they simply couldn’t tolerate such potent medication.

“I can’t take any hardcore pharmaceuticals,” an insomniac told me. “A mild antidepressant, that’s something I’d consider. But I’m afraid of sleeping pills.”

Unlike the Australians, few of the American insomniacs I spoke with had anything good to say about so-called natural sleep aids—herbal teas, melatonin, lavender. Based on my interviews, I would venture to suggest that here in the United States, the concept of the natural sleep aid does not have the strongly positive connotation it has in Australia.

But some Americans said they got relief from insomnia using OTC sleep aids like Benadryl and Unisom, which they felt were likely to be gentler and less harmful than prescription pharmaceuticals.

Accounting for Attitudinal Differences

The differences (and similarities) spelled out here may not be representative of Australians and Americans overall. The sample sizes are small, and the years when the interviews were conducted were different (2013–2014 for the Australian study; 2004–2008 for my book). Physician prescribing patterns and the public health information patients receive about insomnia and sleeping pills may be different as well.

But my point is not to make an evidence-based claim about attitudes in Australia and the United States. Rather, I’m interested in knowing how readers of this blog feel about sleeping pills, OTC sleep medications, and “natural” complementary sleep aids, and why.

Please take a minute to comment below, and like and share on social media. Thank you!

Author: Lois Maharg, The Savvy Insomniac

Lois Maharg has worked with language for many years. She taught ESL, coauthored two textbooks, and then became a reporter, writing about health, education, government, Latino affairs, and food. Her lifelong struggle with insomnia and interest in investigative reporting motivated her to write a book, The Savvy Insomniac: A Personal Journey through Science to Better Sleep. She now freelances as an editor and copy writer at On the Mark Editing.

2 thoughts on “Sleeping Pills: Too Risky, or a Red-State, Blue-State Affair?”

  1. I’ve taken Ambien for 8+ years, and my past doctors made light of my Ambien use. Now I’m 51. I don’t know if it is because I moved but now I can’t find a docter willing to prescribe Ambien, but the’ll prescribe Seroquel, which seems more risky to me. They have frightened me enough to feel I need to wean off all meds, but I also have pain and take 2-3 Norco a day. Stopping Ambien or Norco isn’t as easy as they make it out to be, especially when you have problems in both areas.


    1. Hi Janet,

      The situation is now more difficult for people with pain and/or insomnia who are looking for treatment with medication. We hear a lot these days of people abusing opioid painkillers.

      So a concerted effort is under way to restrict their use following the issuing of new CDC guidelines for the prescription of these drugs. The guidelines are voluntary, and individual physicians may interpret them as they see fit. Still, if you experience chronic pain, it might be wise to see a chronic pain specialist rather than asking for a prescription from a primary care provider.

      A similar sort of situation is occurring with drugs long used to treat insomnia. In recent years, it’s become apparent that long-term use of Ambien and other drugs of its class can in some people have seriously adverse effects: falls requiring hospitalization, car crashes, sleep walking, and so forth. This is particularly true for older people who use these drugs.

      So, because a minority of users experience these negative effects, many physicians are now adopting across-the-board policies that discourage prescribing these drugs to everyone. Here’s a blog post where I describe the situation with Ambien in greater detail:

      About Seroquel (a.k.a. quetiapine), some physicians are prescribing this drug off label for patients with insomnia. I’ve mentioned it in other blog posts:

      In the past I took a dim view of off-label prescribing for insomnia, but more recently I’ve come around to thinking it may not be such a bad idea after all.

      If your sleep problems are ongoing, you may want to consult a sleep specialist. A drug-free treatment called cognitive behavioral therapy for insomnia is growing in popularity (for information on that, click on “Blog” at the top of the page and type “CBT” in the site search box). And a specialist could probably give you better advice about sleep medications as well.

      Thanks for writing in, and good luck with finding ways to manage your pain and trouble sleeping.


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