May 2006: Feeding the Sleeping Pill Addiction

Insomniacs becoming collateral damage in sleep-meds war
May 1, 2006

I recently woke up at three in the morning with the chilling words “collateral damage” ringing in my cranium.

This is standard-issue military techno-speak, a term you’d find in the same bunker as “friendly fire” or “soft targets.” It refers to those unfortunate souls who happened to get killed or maimed, not by something they did, but because they happened to live close to something someone thought was a good target.

The reason this term came to me, flinging my eyelids open at zero dark three zero zero in the morning, is because there are signs to suggest that Big Pharma in the United States has recently launched a drug war over the market for the newest sleeping pills. What this means is that more and more of us unsuspecting and occasional insomniacs are going to get hit with shrapnel as the battles are waged with increasing ferocity.

What is happening is that three rival pharmaceutical companies are busily launching missions for new patients for sleeping pills. One financial analyst can hardly contain his glee, reminding us that these new skirmishes are going to “drive the $3.8 billion insomnia market to new heights.” Okay, that kind of language tends to snap the eyelids open.

Ambien (zolpidem tartate), the market leader, holds the high ground, marketing its drug under the premise that it is “safer” and not dangerously addictive like the older benzodiazepine drugs. The benzos are as old as the hills and have accumulated a few decades of bad press, mostly relating to their crack cocaine-like addictive potential.

With a comfortably wide niche in the market, Ambien has been a stalwart in this war for at least a decade, selling more than 70% of the sleeping pills ingested nightly to American insomniacs. Yet, sensing that its high ground was under assault, its maker, Sanofi-Synthelabo, recently invested more than $50 million in direct-to-consumer TV and print advertising, a blitzkrieg carried by the U.S. media—on TV and radio, in newspapers and magazines--bombarding consumers with messages about the dangers of sleepiness and driving the patient towards what the marketers call a “drug-successful visit.”

Two upstarts who have appeared on the battlefield are Lunesta (eszopiclone), marketed by Sepracor, and Sonata (zaleplon), produced by King Pharmaceuticals. Lunesta’s niche is that it will be the one for people (I guess, like myself) who “wake up too early.” Imagine that: a sleeping pill that doesn’t actually put you to sleep, but is intended to keep you there. Let’s hope its effects wear off before you have to drive to work.

Sonata does the opposite. One ad reads: “If you’re still awake, it’s not too late for Sonata,” and goes on to claim that “Sonata is best for busy patients who don’t have time to sleep eight hours a night, yet turn in late.”

Now that’s a new twist: a sleeping pill that zaps you to sleep as soon as you’ve decided that the late-night talk shows are a bit too lame and you need to slam in a few Zees before that big, important meeting the next day.

Now, I’m not saying some people, at some time, won’t benefit from being chemically induced to enter dreamland. That’s what those drugs should do, but only in emergencies, and only very, very, occasionally. Most of us live nowhere near the blast range of a serious sleeping problem, and yet companies know they can’t build a blockbuster drug market with drugs sold for only occasional, intermittent use. Which makes the question of their addictive nature all the more relevant. If you can capture the patient, maybe the nature of the chemical “fix” will keep them as repeat patients. That’s right. Crack.

The key warhead being used to try to convince more and more Americans that they could use some convenient pharmaceutical enhancement is none other than the handy little self-diagnostic test, such as this handy little “Sleep IQ quiz”:

Do you watch the late show because you can’t fall asleep?

Are you often cranky?

Do you eat spicy foods for dinner?

Do you experience a lot of stress in your life?

And so on. . .

Answer a couple of those in the affirmative and you are set to become a new patient for one of these drugs. The punchline of any self-diagnostic test, by the way, is as blasé and predictable as they come: “See your doctor.”

Who else is going to send you to sleep heaven than a “safe,” monitored prescription drug, available only from your doctor?

And then there is the perennial disease-mongering, promulgated by our friendly media always striving to do the right thing. Some handy examples from the U.S. media:

CNN: “Three out of four Americans have sleep problems.”

MS-NBC: “Too many of us don’t get enough sleep.”

Chicago Tribune: “A good night’s sleep is a pipe-dream.”


But are Americans—and, by extension, Canadians—really the zombies the press would have us believe? Are we really in the midst of an epidemic of sleeplessness? Are we putting ourselves in danger, daily, trying to stay awake while driving or operating heavy machinery, like a photocopier?

I beg to differ. Yet to whom can we turn for trusted advice on this state of affairs?

The National Sleep Foundation, that’s who. And they say: “70 million Americans suffer from sleep problems.”

They also say that three-quarters of adults frequently experience some sort of “sleep problem, including waking at night or snoring.” And “one quarter of us say sleep problems have some effect on our daily life.”

Me? I suffer from a bad case of military terminology that jolts me awake in the middle of the night.

But what about the rest of you? Sure, we’re an overactive, plugged-in, instant-gratification, pill-for-every-ill bunch. And many of us are overactive type-A multi-taskers, sword-juggling our way through life; should we really then be complaining how much our minds buzz in the middle of the night?

A closer look at who funds the production of insomniac propaganda reveals groups like the American Academy of Sleep Medicine and the National Sleep Foundation. They are funded partly by--well, surprise, surprise--the same companies launching tactical nuclear warheads into the general population hoping more of us show up at our doctors with incurable sleeplessness, demanding a prescription.

I should add that the pharmaceutical industry is not alone in disease-mongering our ability to saw a few logs at night. The major manufacturers of “sleep products” (like duvets, mattresses, beds, and other paraphernalia that send us into dreamland) have their fingers in the cookie jar as well.

So, what’s a guy to do, snapping to attention at three in the morning?

Sleep hygiene is the answer. Things like getting enough exercise, not eating full-sized pepperoni pizzas, or not chugging a quart of gin before tucking in for the night seem to be at least one place to start. Fresh air, good covers, and a quiet, dark place to sleep also help.

But do you still have trouble sleeping? All I can say is: don’t become collateral damage in a war that we’ll not win. Do as I do. Get up. Be productive. Write letters to your local newspaper telling them how much you resent being turned into a patient by Big Pharma’s internecine battles.

Anything. Don’t submit.

If all that fails, put on your flak jacket and keep your head down. The shrapnel is flying. . .

(Alan Cassels is the co-author of Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All into Patients, and a drug policy researcher at the University of Victoria, B.C. He is a CCPA Research Associate who has spent most of the last 12 years studying how clinical research about prescription drugs is communicated to policy-makers, prescribers, and consumers.)