These days, insomnia is pretty much part of the national condition. Every evening, millions of Americans use a prescription drug to help them get to sleep and stay asleep – usually a generic version of Ambien (sold under the generic name zolpidem), Sonata (zaleplon), or Lunesta (eszopiclone).
These three medications are all so-called “z-drugs”: Non-benzodiazepines that calm the brain and induce sleep by inducing a sort of hypnotic effect. They’re considered safer to use than the benzodiazepine drugs, which have a higher risk of dependence and overdose.
How effective are these sleep drugs, anyway, and who do they work for best? It’s a straightforward enough question. But answering it isn’t so simple.
One problem is that in clinical trials, sleep medications are usually tested in sleep laboratories. Sleep labs look something like a motel room — there’s a bed and a bedside table, but also a machine that has all sorts of wires connected to it. These wires are hooked up to the study subjects to monitor vital signs as they sleep (or try to sleep). But a sleep lab is a poor proxy for real life. At best the labs are unfamiliar and somewhat uncomfortable; at worst they can heighten the anxiety that can cause insomnia.
And then there’s the problem of sample size: Sleep lab studies are expensive, so many clinical trials include fewer than 1,000 people, and sometimes fewer than 100 people, sleeping in the lab for just one or two nights.
Data from the Real World
People rated these drugs in three respects: 1) how well did they think the drug worked, 2) how much of a hassle – in terms of side effects and other challenges – did the drug create, and 3) what was their overall satisfaction with the drug – a “worth it” score.
So what did people say? For one thing, younger people are less satisfied with sleep medications and find them to be more of a hassle, in terms of side effects – and older people find sleep drugs to work better with fewer side effects.
And then there’s the bottom line: which drug works best. Comparing the “worth it” scores for these three drugs, the Iodine data shows a clear preference for Ambien, in terms of overall satisfaction – the “worth it” score. People taking Ambien (zolpidem) say it’s worth it 67% of the time, while Lunesta (eszopiclone) gets a 55% worth it score, and just 42% of people say Sonata (Zaleplon) is worth it. That leaves a lot of people still unsatisfied with these sleep medications. And that means lots of people are still going to struggle with insomnia, even with medications.
These results are especially interesting compared to published research. A study in Japan that compared eszopiclone (Lunesta) versus zolpidem (Ambien), for instance, found that at doses of 2mg or higher, eszopiclone was comparably effective in helping people fall asleep and more effective in overall sleep efficiency (defined as the percentage of time people stayed asleep). But the effect depended entirely on dose: eszopiclone’s advantage disappeared when it was administered at 1 mg. That’s important because the FDA reduced the recommended dose for eszopiclone from 2 mg to 1 mg, following reports that people on higher doses were less alert in the morning and at a higher risk in activities such as driving a car. This followed an earlier FDA adjustment in the recommended dose for zolpidem in women from 10 mg to 5 mg. (We don’t know the dose for people in our survey).
And here’s where price matters: at GoodRx, prices for zolpidem are around $8 – that’s about half what they are for zaleplon, and 60% cheaper than a prescription for eszopiclone. Considering that people report better satisfaction with zolpidem than the others, it looks like the cheapest drug might also be the one people prefer most. In other words, Ambien (zolpidem) offers the best bang for the buck.
Prices shown are average GoodRx discounted prices as of Dec 6, 2017. Local results may vary.