Side effects you don't hear about

Are sleeping pills the best treatment for sleeplessness? A new report from the Consumer Reports Best Buy Drugs public-information initiative finds that Americans may be jumping to pills too soon when safer remedies are available. Most sleeping pills have side effects ranging from dependency to rebound insomnia, in which symptoms return — and may even worsen — after the person stops taking the pills.

If you're struggling with sleep problems, the report suggests:

First consider nondrug therapies, such as relaxation techniques and improving sleep routines and addressing any underlying health conditions. Learning new sleep habits through cognitive behavioral therapy is an excellent option for insomnia.

You might try over-the-counter products. Both diphenhydramine (found in Nytol and Sominex) and doxylamine (Unisom) are antihistamines approved by the Food and Drug Administration for use as sleep medicines. Yet their side effects include next-day hangover or grogginess, increased urinary retention and dry mouth, so they should be used only in a pinch. Older adults should avoid these products, because they are more likely to experience side effects.

Some studies, meanwhile, suggest the herb valerian may be a mildly effective sleep aid. The hormone melatonin is also said to help initiate sleep and restore normal sleep rhythm if taken regularly at bedtime. Both are available as nutritional supplements — a group of products that are largely unregulated, and, thus, without guarantees as to content or potency.

If your insomnia is chronic — that is, you have trouble sleeping at least three nights a week for a month — you may want to talk to a doctor about prescribing a sleeping pill to be used as needed on a short-term basis. Where once doctors prescribed sedatives and anti-anxiety drugs known collectively as benzodiazepines, they can now choose from a new class of medicines that appear to cause fewer side effects.

Although far from side-effect-free, newer drugs such as Ambien (zolpidem), Lunesta (eszopiclone), Rozerem (ramelteon) and Sonata (zaleplon) have been prescribed in the millions, due at least in part to an advertising blitz from their manufacturers.

Consumer Reports evaluated the safety, effectiveness, side effects and cost of these and other sleeping pills, and concluded that Ambien is best for those who may need a sleep drug for a short time primarily because it is expected to be less expensive when it goes generic later in 2006. Evidence suggests that insomnia is usually resolved with treatment in one to two weeks. Medicines should not be used for longer periods without checking with your doctor.

(on middle-right side of page, scroll down and click on "Sleeping disorders." On new page, look for "Sleeping pills" atop the left column.)