Better sleeping through chemistry? Employees need to know the risks…
In case you missed the last edition of Six Things, it was all about sleep hygiene. We were originally going to lump sleep medications in with sleep hygiene, but, based on what Quizzify has learned from responses to its sleep quizzes, there is enough misunderstanding on the subject of sleep meds that we decided to create a dedicated “Six Things” post, rather than append it to the previous one.
To create some perspective, about 60 million prescriptions are written for these pills every year. Including over-the-counter sleep aids, literally billions of sleeping pills are consumed every year. (Ambien itself has probably been swallowed 20 billion times, including the ones some of us here at Quizzify take.)
And yet wellness vendors normally don’t educate employees on them at all.
Or if they acknowledge the existence of these pills – as in the case of this very popular health risk assessment below– they demonize them. This particular person (more than coincidentally the author of this blog) takes Ambien as directed but drinks rarely and never takes other drugs. And, yet, according to Cerner’s health risk assessment, solely because of the Ambien, this Quizzify employee is HIGH risk for “drug and alcohol.”
This type of demonization might discourage employees from being honest about dependence on sleep aids. Just sayin’…
With or without a doctor’s advice, employees who really can’t sleep – who have tried everything in the previous Six Things sleep hygiene tips with no luck – may medicate the problem. Like it or not, this is what employees are doing. Ignoring the fact that employees take sleeping pills is not helpful.
Wellness vendors often talk of “meeting employees where they are.” This would be a great place to do that. And yet they don’t.
To fill this informational vacuum, we here at Quizzify have taken it upon ourselves to recognize that employees live in the real world, and that real-world issues need to be addressed even if they aren’t fun. (For that reason, we were the first vendor to address opioids https://www.quizzify.com/opioids-employer-quiz.) High on the list of real-world healthcare is sleep medication.
1. Benadryl is probably not safe for long-term nightly use
While Benadryl is one of the safest drugs around for occasional and short-term use, few employees are aware of the risk of nightly use of Benadryl. https://drugabuse.com/hooked-on-benadryl-its-much-more-than-a-harmless-dependency/ The feeling generally is, if it’s over-the-counter and it’s been around forever, it must be pretty harmless. However, as you will learn in our upcoming Six Things Employees Don’t Know About Heartburn Pills, there are very few drugs designed and labeled for short-term use that are safe for long-term regular use.
By way of background, Benadryl is an antihistamine originally developed, using technology older than virtually everyone reading this posting, to relieve allergies. Its sleep-inducing property was originally a bug but is now a feature.
2. Employees may be taking Benadryl without knowing it
Benadryl goes by the generic name of diphenhydramine. It’s contained in – get ready -- 115 over-the-counter drugs. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541127/ Included in that list of drugs are popular products like Advil PM, Aleve PM, and Anacin PM. And that’s just the A’s. The list literally goes from A to Z, with the last entry being ZZZ-Quil.
3. Since they don’t think of Benadryl or these “PM” drugs as sleeping pills, employees may not realize the risk of dependence
Most employees can recognize a sleeping pill when it’s labeled as such. But when they see a familiar name, sold over the counter, they may not realize that it’s the “PM” (or “ZZZ”) part of the name to be concerned about, not the brand name. PM drugs can create a dependence. A dependence is not an addiction but we’ve yet to meet a wellness vendor who knows the difference. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/there-difference-between-physical-dependence Frankly, we didn’t know the difference until we started researching the subject.
4. Ambien may have a less concerning safety profile than OTC drugs containing Benadryl
Some people experience immediate side effects from Ambien, like short-term amnesia. Some side effects – like sleepwalking – are bizarre enough to get in the media every now and then. But the thing about short-term side effects is that you know whether you are experiencing them or not, and can discontinue a drug if you are.
Much more concerning are long-term risks. These are insidious harms to your body that you won’t recognize for years -- and if and when you do, often damage has already been done. Further, sometimes –as will be described in Six Things Employees Don’t Know about Heartburn Pills – the cause-and-effect relationship between the pill and the long-term harm is fairly opaque.
Google on long-term risks of zolpidem (Ambien). You’ll see some. (Don’t pay much attention to the clickbait from addiction recovery centers.) Now google on the long-term risks of Benadryl. Once again, tune out the clickbait. Which list is more concerning to you? We can’t tell you which drug to choose, just that you need to be informed on both and make your own decision.
What you won’t see for Ambien that you will see for Benadryl is dementia. (Once again, this is with long-term regular use. Benadryl is considered very safe for occasional use.) https://www.health.harvard.edu/blog/common-anticholinergic-drugs-like-benadryl-linked-increased-dementia-risk-201501287667
It is unlikely that employees know that.
5. Doctors may prescribe too much Ambien (zolpidem) at first
If you want to take a concrete step right now to help your employees, remove 10 mg. dosages of zolpidem from your formulary. For many years, most doctors prescribed this dosage both initially and, if needed, subsequently. The FDA changed the recommended first dosage to 5 mg. six years ago for women, but many doctors apparently didn’t read that memo. Likewise, PBMs. It is very common for thirty 10 mg. pills to carry the same copay as thirty 5 mg. pills. Hardly an incentive to prescribe or take a lower dose.
Further, employees – men as well as women -- should be advised not only to discuss 5 mg. with their doctor, but also to ask about cutting even that dosage in half to see if it works at 2.5 mg.
Finally, Ambien-type drugs may in very rare cases cause erratic, even injurious, behavior while sleeping. They now have a warning label to that effect. The odds are remote, but all the more reason to start at a half-dose.
6. Even sleep drugs like Lunesta that are labeled for long-term use create a dependence
It is simply not possible, using today’s technology, to create a sleep-inducing drug that does not carry a risk of dependence. Getting labels approved by the FDA is as much sleight-of-hand as it is science. There is really no difference in the likelihood of creating a dependence between Lunesta and Ambien or other sleep aids.
7. BONUS! A seventh thing employees should know
Before your employees get a prescription for a sleep drug, they should match the drug to their problem, rather than just demanding Ambien (zolpidem). Trouble falling asleep? Ambien may be a fit. But if you have trouble staying asleep instead, discuss other options with the doctor. Lunesta may be a better bet, or even something else. https://www.health.harvard.edu/staying-healthy/the-savvy-sleeper-wean-yourself-off-sleep-aids
Few topics are more relevant to more employees -- with more potential for harm if misunderstood. Urge your wellness vendor to address medicinal sleep aids. Or contact Quizzify to learn more about sleep hygiene, sleep meds and other topics.