SLEEPING PILLS, NON-BARBITURATE

COMMON NAMES: goofers, sleepers

If money- spent is any indication, insomnia is one of the most widespread problems affecting, our population. More than 25. million Americans spend in excess of S100 million annually on a variety of medications promising safe and restful sleep, sleep, sleep. Of` those suffering from this malady, one in six resorts to some form of sleeping pill either occasionally or on a regular basis.

Although the most potent and frightening sleep medications are barbiturates (see Barbiturates), many nonbarbiturates also promise relief to the sleepless. In some cases, these promises are worth no more than those maids by the proverbial traveling salesman to the unwary farmer's daughter. Whether prescribed by a physician or self-prescribed, many of these sleeping pills are relatively ineffective and potentially dangerous. .

Using sleepers may backfire by providing the pill-pepper with poor sleep, if any. Physicians and hospitals often prescribe them unnecessarily, to the patient's detriment. In a large number of cases a bit of exercise, some protein, or a little sex would be more effective, less dangerous, and certainly less costly.

A large proportion of insomniacs are actually suffering from "pseudoinsomnia"-- they think they cannot sleep, and thus experience what seems to be insomnia. Many are troubled by anxiety or depression; 24 percent need psychotherapy rather than medication. For these folks, pills we inappropriate and useless. Once assured that they can sleep and are "normal, they often overcome their insomnia. Before rushing to the doctor, drugstore, or medicine cabinet, insomniacs might benefit from consultation with a professional sleep-disorder clinic, which may be able to prescribe a non drug solution to the problem. For the name of one, write to the American Association of Sleep Disorder Centers, University of Cincinnati Sleep Disorder Center, Christian R. Holmes Hospital, Eden and Bethesda Avenues, Cincinnati, Ohio 45219.

If you and your doctor believe sleeping pills are the correct answer, it is important to understand what they can and can not do. Some, will, for the short term, offer, relief from minor insomnia. However, most of the two dozen or so non-barbiturate, sleepers available become ineffective after two weeks of continuous use. Only one has done better than that in sleep-lab tests. A large percentage of the public mistakenly believes that sleepers can provide long-term effectiveness; despite the fact that recent tests indicate insomniacs using no medication at all sleep as well as those taking pills for ex tended periods. Still, many keep popping them until unexpected, ugly side effects appear.

The granddaddy of all hypnotic sleepers, chloral hydrate, was introduced medically in 1869. The drug is usually found in soft gelatin capsules and can be administered orally or rectally. Chloral hydrate combined with alcohol - the movies' famous "Mickey Finn"- can knock you out or even kill you. Along with paraldehyde, another popular drug with an , equally unpleasant taste and odor, chloral hydrate fell into disfavor when barbiturates were later developed. Because chloral hydrate has an irritant effect on the gastrointestinal tract, addicts often suffer from extreme stomach disturbances.

The most popular and safest prescription sedative today is Dalmane, a member of the benzodiazepine substance group which is related chemically to tranquilizers such as Valium and Librium. Dalmane legally sells for 10 to 20 cents per pill.

By comparison, barbiturates cost about a penny each. What does one get for this high price? For some, as many as twenty eight nights of insomnia relief. For' others, not much at all. When it works, effects begin' in about twenty minutes, with sleep lasting seven to eight hours. Dependence is uncommon unless the drug is taken for an extended period of time, more than three months. A small percentage of users experience various adverse side reactions to Dalmane and other sleepers, . including dizziness, loss of coordination, euphoria, headache, nausea, coma, diarrhea, irritability, constipation, fear, palpitations, flushes, loss of appetite, sweating, hallucinations, blurred vision, and even hyperactivity. Because sleepers are central-nervous-system depressants, users should avoid alcohol, as the combination can be synergistically dangerous. Driving or operating complex heavy equipment should be avoided; Indications are; that suicide, accidental or planned, is possible with sleepers, particularly when combined with other drugs.

In addition to Dalmane, other popular nonbarbiturate sleepers are Doriden, Placidyl, Valmid, Noludar, Sopor, and Quaalude (see Methaqualone), paraldehyde, and the chloral hydrates, Noctec, Somnos, Aquachloral, and Kessodrate. All fall within the same price range, yet none is medically effective for more than two weeks, if at all. Generally, these drugs produce results within fifteen minutes to an hour, providing some users with four to eight hours of sleep. Doriden and Quaalude top the abuse list. Abusers usually seek these drugs out not as a cure for insomnia, but rather for a cheap, euphoric boozeless drunk with an accompanying I of inhibitions. To a much greater degree than Daimane, and to a lesser degree than barbiturates, they can be habit forming.

Withdrawal after heavy abuse can produce mental and physical symptoms similar to those seen in cases of barbiturate addiction, including hangover, delirium tremens, convulsions, and death. Severe dependence requires professional, closely supervised medical attention. Treatment may include step-by-step withdrawal, or. substitution of a barbiturate equal to the quantity of nonbarbiturate sedative taken each day. Withdrawal from the barbiturate then follows. Psychiatric help may also be required.

People with liver, kidney, and heart problems should' seek advice from their physicians before using hypnotic-sedatives, as should those taking anticoagulants. The, depressed and suicidal should use sleepers with caution.

Nonbarbiturate sedatives are regulated under the Comprehensive Drug Abuse Prevention and Control Act of 1970. Penalties are provided for illicit possession, manufacture, and sale.

Less abused, but also capable of producing mild psychological dependence, are over-the-counter sedatives, available without prescription. Many brands are aggressively marketed, the most popular being Nytol, Sleep-Eze, Sominex, Compoz, and Sure-Sleep. These preparations are a combination of ingredients usually containing salicylamide, an aspirin-like agent capable of producing minor calming action, antihistamines, and, in some cases, scopolamine. Some claim scopolamine, when taken in larger than recommended doses, can cause adverse reactions including loss of memory hallucination, reduction of academic performance, and general look of stupidity. Although recently judged unsafe y a Food and Drug Administration panel, scopolamine can still be purchased at will by the unwary.

The best bet for insomniacs: Avoid sleepers completely, if possible. Most will not help for more than a couple of weeks and many will actually interfere with sleep beyond that point. Seek information about insomnia remedies from a sleep-disorder clinic or, discuss other non-meddicinal approaches to the problem with your physician.