Amidst a global rise in reported sleep disturbances,particularly following the COVID-19 pandemic,the use of the prescription sleep aid zolpidem is facing increased scrutiny.Medical specialists in Brazil are now classifying the growing trend as a public health issue, with sales of the drug-the country’s third most-sold hypnotic behind clonazepam and alprazolam-increasing 139% between 2014 and 2021. Experts are now urging caution regarding long-term use and highlighting the potential for dependence and adverse effects, prompting new guidelines and stricter sales controls.
The increasing use of the sleep medication zolpidem is raising concerns among medical specialists, who are classifying the trend as a public health issue. Experts in neurology, psychiatry, psychobiology, and sleep medicine recently released a consensus statement regarding the drug’s use.
Zolpidem, a sedative-hypnotic commonly prescribed for insomnia, is now the third most-sold hypnotic drug in Brazil, according to data from the National Health Surveillance Agency (Anvisa), surpassed only by clonazepam and alprazolam. Sales volume increased by 139% between 2014 and 2021, rising from 338,367 to 810,353 boxes.
The unauthorized sale of zolpidem has contributed to the growing concern, with the drug frequently being sold without a prescription or illegally within Brazil. This prompted the development of the recent guidelines.
Paulo Afonso Mei, coordinator of the Brazilian Academy of Neurology’s (ABN) Department of Sleep Science and one of the authors of the consensus statement, noted that the COVID-19 pandemic also played a role in increased zolpidem consumption. He explained that the pandemic led to a surge in diagnoses of mental health disorders, which often present with sleep disturbances.
“There was a very clear perception within the medical community of an explosion in these diagnoses,” Mei said. “In my own studies, I observed a roughly 40% increase in the proportion of patients reporting sleep-related complaints.”
The expansion of telehealth and digital prescriptions during periods of social distancing and isolation may have also contributed to the increased use of the medication, according to the experts.
In response to the rising consumption, Anvisa implemented stricter controls on zolpidem sales last year, increasing oversight of prescriptions and requiring the use of special “blue” prescription forms. Mei stated that this measure helped to curb the trend, noting, “It was the only impactful action that proved effective in containing prescriptions.”
Zolpidem, first marketed in the 1990s, gained popularity due to its perceived milder side effects compared to other psychotropic drugs like clonazepam and alprazolam. However, as its use became more widespread, so did reports of dependence.
Online, individuals are increasingly sharing experiences of dependence on the medication to achieve sleep. The consensus statement highlights the potential for addiction as a significant concern.
The drug’s labeling has always included a recommendation for a maximum of four weeks of consecutive use, but Mei lamented that “this is rarely respected.” He emphasized the importance of preventing long-term use when prescribing the medication.
Reports of side effects, including sleepwalking, are also increasing. Mei explained that zolpidem can induce amnesic behavior, leading to actions the user doesn’t remember, potentially resulting in injuries. There have even been cases of individuals committing illegal acts while under the influence of the drug, underscoring the severity of the issue.
While still effective for acute insomnia, the medication is not recommended for chronic use, as is often the case, according to Mei. This is particularly important because many patients seeking medical help present with chronic insomnia, defined as difficulty initiating or maintaining sleep for more than three months.
The increasing reliance on sleep aids underscores the importance of addressing underlying sleep disorders and promoting healthy sleep habits.
How to Improve Sleep Quality
Although zolpidem can be appropriate for short-term treatment of insomnia, it’s not the only way to achieve restful sleep. The consensus statement emphasizes that cognitive behavioral therapy (CBT) should be the first-line treatment for insomnia patients, and is also effective in helping adults and seniors discontinue “Z-drugs.”
Mei noted that CBT treatment is typically brief, with significant improvements often observed after just six to ten sessions.
In addition to therapy, he recommends practicing good “sleep hygiene,” which involves adjusting routines and the sleep environment to promote quality rest.
Steps for Better Sleep Hygiene:
- Reduce light exposure, especially artificial light.
- Establish regular sleep and wake times.
- Create a calm and comfortable sleep environment, avoiding stimulating activities in bed.
- Avoid using electronic devices close to bedtime.
- Limit intense physical activity in the evening.
- Eat a light meal before bed.
- Avoid dwelling on worries in bed and write down pending tasks for the next day.
- Limit alcohol and caffeine consumption at night.
- Avoid working or watching television in bed.
- Incorporate relaxing rituals, such as meditation or reading, before sleep.
