It happens all the time — you’re under the gun at work, say with a new boss or assignment, staying at the office late, leaving early in the morning, fretting in bed.
Some 8.6 million Americans take sleeping pills, for any number of reasons. But if you have a new prescription and need to drive in the morning, be careful you don’t become a statistic in a new kind of “DUI,” “driving under the influence” of sleep meds.
New users need to closely monitor the effect on their driving and take precautions, which includes aiming for at least 7 hours of rest before you get behind a steering wheel. Any of the most popular pills increases your risk of a car crash, a study of more than 400,000 Washington state adult drivers concluded — though zolpidem (Ambien) was riskiest. Another large study found that taking zolpidem increased your chances of being hospitalized for major injuries. A third report found that emergency room (ER) visits after bad reactions to zolpidem increased 220 percent from 2005 to 2010.
Women process zolpidem more slowly than men and are more likely to react badly to it: Most of the ER patients were women age 45 or older. In 2013, the Food and Drug Administration (FDA) ordered that manufacturers cut in half the recommended dose for women, based in part on research showing that zolpidem stays in the bloodstream at levels high enough to affect a morning drive. The agency landed on 5 milligrams, or 6.25 milligrams for extended-release pills. But doctors sometimes prescribe women more, and if you’re borrowing from your husband or friend — note, this is a bad idea — you could be taking the older, more potent pills.
The FDA suggests men take the lower dose as well and that everyone aim to take as little as necessary.
In the Washington state study, researchers examined the records of all adult drivers in a particular state health plan from 2003 to 2008. Just under 6 percent received new prescriptions for sleep aids in that period. The team collected data on zolpidem; trazodone, sometimes sold as Oleptro; and temazepam, or Restoril. If you had received a new prescription for zolpidem in those five years you had more than double the chance of a car crash in that time than people who didn’t take a pill. Trazadone users had around double the risk and Restoril-users a 27 percent higher risk.
Those risks make driving under the influence of sleeping pills “equivalent to blood alcohol concentration levels between 0.06 percent and 0.11 percent." The legal limit in all states for blood alcohol is 0.08 percent.
What else can you do to get enough sleep? Instead of a prescription sleeping pill, you might try taking a .5 mg melatonin supplement several hours before your usual bedtime. But first take a full inventory of your habits. Do you need more exercise? Do you wake up with heartburn? Stay away from the refrigerator and electronic devices, including TV, well before your bedtime. Make sure you have a regular bedtime, and stick to the routine on weekends. Ideally, you should be able to wake up without an alarm. If you need to make up for lost time, try napping during the day rather than sleeping late in the morning. If you find yourself getting sleepy long before your bedtime, do something mildly stimulating that doesn’t require electronics: washing the dishes, calling a friend, or laying our clothes.
August 12, 2015
Janet O’Dell, RN