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Are your sleeping pills harming you?

Talk about a wake-up call: A study released last month rattled those who need a little help getting shut-eye because it linked sleeping pill use with premature death.

The more pills taken in a year, the greater the risk, the study reported.

Though it found that risk rose with just 18 pills a year and continued rising as the number of pills increased, the researchers acknowledged that the findings weren't conclusive and that the problem could stem from medical conditions that cause insomnia in the first place, not the drugs themselves.

Still, plenty of people wondered if their sleep aids could spell trouble. Some estimates say that as many as one in 10 people in the United States takes sleeping pills.

Long Island sleep specialists acknowledge that sleeping pills, like any medications, do pose risks and come with potential side effects but say that for some people, long-term use -- even for years -- is fine.

The crucial thing, they stress, is to make sure that insomnia is the problem rather than another condition, like sleep apnea, that should be treated differently.


MANAGING A SYMPTOM

"I've had patients on sleeping pills for years, but I've done the research to show that they don't have another problem," said Dr. Laurence Engelberg, medical director of the Good Samaritan Hospital Sleep Apnea Center in West Islip. "If you give somebody sleeping pills in the long term for a disease that requires a different kind of treatment, I can see why that might shorten your life span."

If people are having trouble sleeping on a regular basis, don't automatically turn to the medicine cabinet, health experts say, but instead get medical help to investigate what might be going on.

"Insomnia is a symptom, and using a sleeping pill is management of the symptom," said Dr. Rina Awan, an assistant professor of medicine at Stony Brook University Medical Center. "The underlying problem which is causing the insomnia might continue to get worse."

Sleeping pills can mask and worsen the symptoms of sleep apnea in particular, Engelberg said. People with sleep apnea, who can subconsciously wake up as many as dozens of times an hour, are at higher risk for such cardiovascular problems as high blood pressure and stroke. He said that sleeping pills can relax the throat so that the awakenings become even more common.

"I don't hand these drugs out ... unless I know that I'm treating insomnia and not sleep apnea," Engelberg said.

If a doctor's examination and perhaps a sleep study -- in which someone sleeps while being monitored -- rules out sleep apnea, then what?

For occasional sleeplessness, over-the-counter medications are best, said Dr. Fulvia Milite, a sleep specialist with Long Island Heart Associates and Mount Sinai Medical Center. But, she said, most contain antihistamines that can lose effectiveness over time.

As for prescription sleep aids, they're best for people who have trouble sleeping more than a few consecutive nights, Milite said. In general, she said, it's OK to take them over the long term as long as any underlying medical issues have been evaluated and treated.

Addiction was once a major issue with sleeping pills, but the newer generation of these medications -- including Ambien (zolpidem), Lunesta (eszopiclone) and Sonata (zaleplon) -- has not been shown to cause addiction when taken in recommended doses, Milite said, although other kinds of sleeping pills can cause addiction. Sleeping pills can also increase the chances of falling when taken by elderly people, and they should not be used with alcohol or medications that suppress the respiratory system, she said.

Ideally, she said, "the goal is to wean the patient off medication completely when the insomnia resolves."


CONCERNS ABOUT CANCER

As for long-term risk, Milite said that the study that sparked the latest concerns also found an increased rate for cancer after following a group of people on sleep medication for 21/2 years.

However, she said, "there are many limitations to this finding, and it is unclear if these patients had undiagnosed cancer when entered into the study." The study, done by U.S. researchers and published in the British medical journal BMJ Open, showed only an association and was not designed to prove cause and effect, for instance.

Dr. Steven J. Walerstein, executive vice president for medical affairs and medical director for the NuHealth-Nassau University Medical Center, said that a handful of other studies have come up with similar conclusions, but "none of those studies are particularly robust from a purely scientific point of view."

"I don't think we should overreact and say there is a clear association between sleep medications and death," Walerstein said.

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