Doctors increasingly prescribe the drugs for youths despite a lack of FDA approval for such uses.
By wire services
Published October 19, 2005
The use of sleeping pills among children and very young adults rose 85 percent between 2000 and 2004, in yet another sign that parents and physicians are increasingly turning to prescription medications to solve childhood health and behavioral problems.
More than 181,000 children and young adults in the United States between ages 10 and 19 were given sleeping pills in 2004, out of the more than 41-million people in that age range, according to the study by Medco Health Solutions, a managed care company.
Few of these prescriptions have the approval of the Food and Drug Administration, because no sleep medication has been approved for use in children under 18. Still, doctors commonly use medications for patients and disorders for which the drugs have never received formal approval, particularly when those patients are children.
About 15 percent of those under age 20 who received sleeping pills were also being given drugs to treat attention deficit and hyperactivity disorder, Medco found. Drugs that treat the disorder can cause insomnia.
"It leads you to wonder whether these children are being treated for insomnia caused by hyperactivity or whether the medication itself causes the insomnia," said Dr. Robert Epstein, Medco's chief medical officer.
The use of sleeping medicines among adults doubled from 2000 to 2004, Medco found.
The older the person, the more likely they were to use sleeping pills, according to the study. Of those between ages 20 and 44, nearly 3 percent - or 2.8-million people - got prescriptions for sleep medicines in 2004, Medco found. More than 5 percent of those between ages 45 and 64, or 3.3-million people, used the pills that year, while more than 6 percent of those over age 65, or more than 2.2-million elderly Americans, took sleeping pills, according to Medco.
At every age, girls and women were more likely than boys and men to take sleeping pills. Among the elderly, for instance, roughly twice as many women as men got the drugs in 2004, Medco found.
"Although the elderly are still the most frequent users of sleeping aids, the evidence found in this study shows that younger adults and children are starting to use these medications with even greater frequency," Epstein said.
The increase is part of a broader rise in prescriptions for children, particularly for behavioral medicines, said Ann Smith, a Medco spokeswoman.
Expensive marketing campaigns by makers of sleeping pills were an important factor behind the rising drug use, several experts told the New York Times. And because those campaigns expanded in 2005 after the introduction of a new pill, Lunesta, the experts said that the drugs' use likely increased even faster this year. Medco did not have data for 2005.
Executives at Sepracor, Lunesta's maker, have boasted that their advertising spending initially rivaled that of McDonald's.
The trend toward medicating children and teenagers off to dreamland is "alarming," said Dr. Dean Karampelas, director of the sleep disorders center at St. Anthony's Hospital in St. Petersburg.
"Basically, you're having these young people get into the world of poly-pharmacy, and it's a very bad precedent to start," Karampelas said. "What they're doing, unfortunately, is they may be making a wrong diagnosis. It probably could be handled without drugs."
For example, Karampelas said, children and teens may be suffering from undiagnosed sleep apnea, a condition in which the person repeatedly stops breathing during sleep. But while adults with apnea usually become sleepy during the day, juveniles with apnea can become hyperactive.
Those children may be incorrectly diagnosed with attention-deficit disorder and given a stimulant, such as Ritalin. But then the Ritalin makes it harder to sleep, so the child is given sleeping pills.
"Then you're compounding the problem," Karampelas said. "It fosters this misdiagnosis that continues."
Teenagers also may have sleep problems because they become so busy that they skip sleeping, then upset their biological clock. Or they may fall into a pattern of staying up late, then wanting to sleep late.
Such problems generally are better treated by teaching the child relaxation techniques and other behaviors to help sleep, Karampelas said.
Teenagers also might have problems sleeping because they're depressed. Karampelas said medicating such teens can cause two problems. First, a sedating sleeping pill may make the teen even more depressed. Second, the teen has easy access to a sedative that could be used in a suicide attempt.
About the only time it's wise to give sleeping pills to young people is in "acute grieving," such as when a parent dies, Karampelas said, and then only for a short time. Although Karampelas treats mostly adults, he couldn't remember ever giving a child or teen a prescription for sleep medication for chronic insomnia.
In Tampa, sleep disorders specialist Dr. Cheryl Carlucci also is concerned about the rising number of sleeping pill prescriptions. The rapid increase suggests that many prescriptions are being written by general practitioners, rather than people studying disorders, said Carlucci, an assistant professor of neurology at the University of South Florida College of Medicine.
"First you want to make sure what you're dealing with," Carlucci said. "Are you dealing with someone who's an intrinsically poor sleeper? Or is it because of stress and behavioral changes?"
Carlucci treats adults, but said it's especially important to examine children's sleep problems thoroughly before prescribing drugs for them.
"You have to give kids the right diagnosis," she said.
Times staff writer Lisa Greene contributed to this report, which includes information from the New York Times.
