By the way, doctor: Are sleeping pills addictive?
Q. My primary care doctor tells me that all sleeping pills on the market are addictive. Does this mean you develop a craving for them or simply that you become unable to sleep without taking them? I'm 92 and realize that easy sleep and age aren't compatible. Please advise.
A. I'd call sleeping pills variably addictive. People don't crave them the way that, say, a heroin addict craves heroin. But many people do become psychologically dependent — they believe they can't sleep without them. And it's not just in their heads, either. If people take sleeping pills for a while and then stop, they often experience a rebound effect, becoming more wakeful and restless and agitated at bedtime than ever before.
But as a geriatrician, I don't worry as much about dependence and rebound as I do side effects. Sleeping pills — especially the longer-acting benzodiazepines like diazepam (Valium) and flurazepam (Dalmane) — linger in the body, so people feel drowsy and "out of it" during the day. Drowsiness, particularly among older people, causes falls and accidents. Shorter-acting sleeping pills were developed to avoid this problem, but in my experience, some people develop a tolerance for them, so they wind up taking more pills to get the same sleep-inducing effect and daytime sleepiness still is a problem.