Sleeping pills, rechristened as sleep medications, are becoming increasingly accepted and a prescribed drug for young adults and even children.
The use of prescription sleeping pills among people ages 20 to 44 doubled from 2000 to 2004, according to an analysis of insurance claims by Medco Health Solutions, which administers prescription drug plans.
Further, the number of children who were on sleep medication rose 85 percent. The use isn't widespread, an estimated 181,050 children, or 0.22 percent of the population 19 and younger, take the drugs. Still, the increase came even though none of the most popular drugs are approved for use in children. Nationally, 8.6 million people took prescription drugs to help them sleep last year. That's up from 5.5 million in 2000. Depending on the age group examined, that's 2.7 percent to 6.4 percent of the population. And the trend toward increased use, particularly among adults under 65, is clear.
"This is an unusually sharp increase," said Lon Castle, a family physician and director of medical policies and procedures for Medco.
The increased use raises concerns about whether the drugs, heavily marketed through consumer advertising by pharmaceutical companies, are being used appropriately.
Americans spent $2.1 billion in 2004 on prescription drugs to help them sleep, according to IMS Health, a pharmaceutical information and consulting company. That's up from $900 million in 2000. With several new drugs now on the market, and others about to be introduced, sales of sleeping medications are expected to double in coming years.
The growing acceptance of sleeping pills reflects broader trends in health care and society. It is now more socially acceptable to take prescription drugs, and people are more willing to seek such medications, despite the potential side effects.
"We have this idea that there is a pill for every ill," said Jon Schommer, a professor at the University of Minnesota's College of Pharmacy.
Schommer and others talk about the "medicalization" of normal human experience: Drugs are increasingly available to treat aliments or symptoms once considered a normal part of life.
"We all have these ups and downs in sleeping," he said.
The roughly $3 billion a year spent by pharmaceutical companies to advertise prescription drugs directly to consumers has contributed to this new attitude. At the same time, taking a pill is easier than making lifestyle changes that can address the underlying causes of a disorder.
Marc Olsen, a family physician with Advanced Healthcare S.C., said he is seeing more patients ask for sleeping medications, although he hasn't seen the increased use among children.
"It's just recently that the use seems to have increased," he added.
Job-related stress, and people's willingness to talk about it, is a factor. So, too, are the consumer ads.
"There's an increased awareness that those drugs are out there," Olsen said.
Sleeping medications account for less than 1 percent of the $235.4 billion spent on prescription drugs last year, according to IMS Healthcare. But the sharp increase since 2000 shows how new drugs can increase the cost of prescription drug coverage for employers and government health programs.
The increase stems in part from a new class of sleeping medications that have fewer or less severe side effects than the drugs previously available.
"Older medications knocked you over the head and got you to sleep," Castle said.
There also is a growing awareness of sleeping disorders, in part because of advertising for drugs such as Ambien, Lunesta and Sonata. And many doctors believe sleeping disorders remain largely untreated or unrecognized.
The National Institutes of Health estimates that more than 70 million people in the United States may have trouble sleeping, according to Medco, and for 42 million, trouble sleeping is a chronic disorder.
Yet doctors and pharmacists note that sleeping medications, just like all drugs, are not without risks.
"We have to be careful that we are not ending up with a lot of addictive behavior here," said Beckie Fenrick, a pharmacist with Innoviant Inc., a pharmacy benefits manager in Wausau, Wis.
Innoviant, part of the Fiserv Health Solutions Group, has seen the same increase in the use of sleep medications as Medco.
It also found that more children are taking the drugs. From 2002 to Sept. 30 of this year, the number of children being prescribed sleeping pills rose 92 percent.
"The one caveat to that is it is still a really small number," Fenrick said.
It's not uncommon for pediatricians to recommend an over-the-counter sleep medication. But the growing use of prescription drugs in children- albeit still low- stood out in Medco's analysis.
"These drugs have not been well studied in the pediatric population," said Fenrick, who has a doctorate in pharmacy. "Yet they are being prescribed there."
One concern is that children won't learn how to sleep.
"Children have issues going to sleep," said Medco's Castle. "They always have."
Sleeping medications, if used judiciously, are appropriate for children, he said.
But Castle and other doctors said that parents should look at why their child is not sleeping.
"I am worried that we are not getting to the root causes," he said.
The Medco analysis found that 15 percent of the children with prescriptions for sleeping medications also were taking drugs for attention deficit hyperactivity disorder.
The drugs used to treat ADHD, with one exception, are stimulants that can cause insomnia. In other words, a child could be taking a stimulant during the day and a depressant to sleep at night.
"It kinds of gets you into this vicious cycle," said Lynn D'Andrea, a professor at the Medical College of Wisconsin who is board certified in pediatric pulmonology and sleep medicine.
The market for sleeping medications has increased across all age groups, according to Medco's analysis. Although the largest increase was among adults ages 20 to 44, sales to adults 45 to 64 increased 61 percent. Roughly one in 20 adults in that age group now takes prescription drugs to help them sleep.
The smallest increase- 16 percent- was among people 65 and older. An estimated 6.4 percent of the people in that age group take prescription sleep medications.
Although the new sleep medications have fewer restrictions on their use, they are not without side effects.
"They come with such great benefits, but they still do have risks," said Schommer of the University of Minnesota.
The Web site for Lunesta, a sleeping drug introduced this year, warns that people should have at least eight hours to sleep before becoming active after taking the drug, and extreme care should be used when driving a car or operating machinery the next morning.
