My patient was having a relaxed Shore weekend. She drank a few margaritas spaced out over a few hours, ate dinner, and then got into bed.

She took her Ambien, as she has for the last six years, and said goodnight to her husband, who was going out to buy some band-aids.

When he returned, she wasn't in bed but rather lying unconscious in the doorway to the back porch. A lot could have gone wrong, but luckily for my patient, whom I met a few weeks ago in the emergency room, her head was OK and she had only suffered an orbital fracture. These bones surround the eye and did their job. She had no actual eye injury.

My patient had read about people taking sleeping pills and then sleepwalking and going to the kitchen to eat, as she had tried to do.

A couple of years ago, the Food and Drug Administration put out a warning saying that mixing the pills with alcohol could result in sleepwalking, "sleepdriving," and nocturnal binge eating. People would wake up with Snickers wrappers in their beds or find their stoves lit in the morning.

Although she had mixed martinis and other such drinks with her sleeping pill in the past, she had never had a problem like this one. She thought that by being in her bed when she took her sleeping pill, she would be safe.

The side effects of these pills may be not only bizarre but quite detrimental. Some studies have shown that long-acting sleeping pills increase the risk of motor vehicle accidents. Others have demonstrated that such pills are a major risk factor for fractures in the elderly. Sleeping pills also can cause daytime sleepiness and dangerous amnesia.

One of my friends, also a resident-in-training, had taken an Ambien for the first time on a flight back from his honeymoon in Hawaii. Apparently, he was the only doctor on the plane, and when a patient was having chest pain, the stewardess found him and asked if they should turn the plane around. He did not get up to examine the patient and just told her that the patient's chest pain was probably from reflux, not from the heart. And he went back to sleep.

When the plane landed, my friend's new wife told him that the person with chest pain was feeling a lot better. To which he responded, "What chest pain?" He didn't remember a single detail of the encounter.

Despite such side effects, these pills are popular. Use has increased by 60 percent since 2000, with annual sales exceeding $3 billion in recent years. Many people in America are sleepless. About 10 percent to 15 percent of Americans have chronic insomnia, and the rates are even higher in the elderly, with up to half enduring some type of sleep problem.

The causes of insomnia vary. One factor patients can control is what experts call "sleep hygiene." People who drink caffeine later in the day, for example, can have difficulty falling sleep. While alcohol is initially sedating, it actually causes lighter sleep and increased awakenings in the later part of the night. Exercise and eating right - this is no surprise - can improve sleep patterns.

Some people can't live without their sleeping pill. But many experts believe in trying cognitive behavior therapy before delving into the pharmacopia.

One strategy of such therapy is "stimulus-control" therapy, where the factors leading to insomnia are analyzed - such as watching TV in bed instead of only sleeping in bed - and then modified through a learning process where the bed is reassociated with sleep.

Another strategy called "restriction-sleep therapy" is when a person learns how to increase sleep time by temporarily depriving him or herself of time in bed.

My patient started having trouble sleeping after a death in the family. Her doctor started her on a sleeping pill and it made her nights much more restful.

After this scare, will she continue? Yes. But let's hope she leaves out the mixed drinks.

Contact Rachel K. Sobel at rachelkimsobel@gmail.com.