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New Generation Sleeping Pills May Be Kindler and Gentler

Dr. Tracey Marks explores the new generation of sleeping pills.  Not right for every day and not right for everybody, is it possible to get "closer," to a remedy for those hard to sleep nights?

Many people who take sleeping pills face the common problem of the unwanted after effects of the next day.  Some feel the excessive sedation or sluggishness is not worth the trade-off for improved sleep.   Not only may you find yourself having trouble waking in the morning, but you may also think slower during those first few hours of work.


The ideal sleeping pill is one that puts you to sleep quickly, allows you to sleep through the night and then allows you to wake up refreshed with no morning hangover.  Unfortunately, no such sleeping pill exists.  Typically the medications that help you fall asleep quickly are not as helpful in sustaining your sleep throughout the night.  Then there are the sleeping medications that help you fall asleep and allow you to sleep deeply, but then you can have significant difficulty waking up with clear thinking.  In some cases you may need to delay driving to work an hour or two until the medication wears off.


Alas after many years, researchers have targeted a new medication to address sleep without the next day sedation or effects on your memory and thinking.  Traditional sleeping pills work at the GABA receptors in the brain.  GABA promotes sleep during the night and these medications act to enhance this brain chemical.  The downside though, is potential memory problems the next day which is thought to be due to a reduction in your deep sleep at night.


The newer class of medication targets the brain chemical Orexin, which is a wakefulness-promoting agent to keep you awake during the day.  For some people, the effects of Orexin last through the night and inhibit sleep.  The new drugs would decrease Orexin secretion in order to improve your sleep.  


These drugs are still in the research phase and thus far show promise with animal studies that they do not have the same side effects as our current sleeping medications.  At present, they are also showing less physical tolerance which means that you can take it longer before it stops working.  This attribute would make them less habit forming.


All of this sounds very promising, but we still have some hurdles to overcome with the human trials to ensure that what these drugs are showing in animal studies continue when we humans take them.   But we are getting close as it appears that Merck Pharmaceuticals is the closest to approval with the drug Suvorexant.  Thus far, this drug is under review with the FDA.


Although long term management of sleep is best addressed with behavioral approaches, sometimes sleeping medication is required and especially helpful for a short-term and temporary sleep solution.  It is encouraging that sleeping medications are continuing to be refined to make them more tolerable and effective.