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What To Use Instead of Sleeping Pills

Thomas J. Coates, PhD; Carl E. Thoresen, PhD
JAMA. 1978;240(21):2311-2312. doi:10.1001/jama.1978.03290210093042.
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FIFTEEN to 20 million Americans suffer chronically from the tyranny of insomnia. Over-the-counter medications, the first line of defense, have little impact on sleep beyond placebo effects. Ironically, antihistamines in them can increase daytime drowsiness and may enhance the person's belief that sleep is getting worse. When these drugs fail, the chronic sufferer often turns to the physician, who is expected to be ready with medically proved answers.

Twenty-seven million prescriptions were written for hypnotics in 1976. Barbiturates, accounting for 20% of these prescriptions, lead to a predictable cycle of dependence, tolerance, and escalating doses. These medications also disrupt the sleep structure. Rapid eye movement (REM) and slow-wave sleep (stages 3 and 4) are suppressed, and the EEG shows increased β activity. Physical and psychological dependence, withdrawal reactions, and "REM rebound" reactions (severe nightmares and sleep more disturbed than before taking medication) often accompany attempts to stop using these drugs.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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