In the ads for the new sleep drug Lunesta, a pale green luna moth — they're nocturnal — floats peacefully across the TV or computer screen, hoping to lure you into asking your doctor to prescribe the medication.

What the $60 million ad campaign doesn't mention is that there's little research showing Lunesta works any better than prescription sleep aids already on the market. Also, sleep experts say there are drug-free ways to get a good night's sleep.

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Insomnia plagues an estimated 70 million Americans, according to the National Institutes of Health, and many of them seek prescriptions as a quick route to a good night's sleep.

"I try to encourage people not to use these medicines because of side effects," said Dr. Glenn Singer, who leads the sleep disorders center at Broward General Medical Center in Fort Lauderdale, Fla. Singer said some people become dependent on the medications.

"We don't call it addiction, we call it habituation," he said. "We want people to learn how to sleep better, and there are other ways of doing that."

Neal Nay, manager of the sleep disorders center at JFK Medical Center in Atlantis, agrees that lifestyle changes can be very effective in treating insomnia. He recommends simple approaches, such as getting out of bed and reading until you're drowsy, to get a good night's sleep.

"We encourage (insomniacs) to read something kind of boring, not a romance novel or a suspense novel," he said. "Teach yourself Latin. That should make you drowsy."

Despite such advice, the appeal of sleep medications remains strong.

Sales of Lunesta, launched in early 2005, have been brisk. Ambien and its latest version, Ambien CR, are big sellers, too, along with Sonata and other prescription sleep medications. Americans filled more than 35 million prescriptions for sleeping pills in 2004 at a cost of $2.1 billion, according to a recent study by managed-care company Medco Health Solutions.

The medications, in a class called "sedative/hypnotics," work by enhancing brain chemicals that allow the mind to calm and for drowsiness to occur.

People 65 and older are most likely to get sleeping pill prescriptions, Medco found, based on an analysis of prescription drug claims of 2.4 million Americans between 2000 and 2004. But use of the pills in adults 20 to 44 doubled during that four-year span, the study showed.

Consumer advocates say Lunesta and Ambien are the latest in a series of medications that have been marketed directly to consumers since federal law was relaxed to allow such sales tactics by pharmaceutical manufacturers in 1997.

Often, new treatments are touted as better than existing options, which may drive patients to pressure their doctors to prescribe them.

But health experts say older medications can be more reliable, less expensive and have longer track records for safety.

Heavily marketed Vioxx, for example, a $2.5 billion a year blockbuster drug that provided pain relief to millions of people, was withdrawn after it was found to increase the risk of heart attacks and stroke in patients.

The popular newer sleep medications have not been shown to harm patients, but a recent analysis of 141 studies of Sonata, Ambien, Lunesta and Imovane, a Canadian brand, found that none stands out as the best, and that all have short-term side effects such as daytime sleepiness and headaches.

Reviewers at the Oregon Evidence-based Practice Center at the Oregon Health and Science University said no comparative studies have tracked the long-term effectiveness and safety of sleep drugs. They recommended further comparative studies, noting that the longest placebo-controlled study for any of the sleep medications was six months.

While doctors say there are circumstances in which people can benefit from taking a sleeping pill, many causes of insomnia are tied to lifestyle choices: drinking caffeinated beverages with dinner or later, eating chocolate or exercising right before bed.

Insomnia takes a few forms — difficulty falling asleep, or falling asleep but waking early and then not being able to go back to sleep, or waking frequently, said Dr. Laurence Smolley, medical director of the sleep disorders center at Cleveland Clinic Florida in Weston.

People who wake frequently in the night may need to be studied to determine whether they have sleep apnea, a condition in which the throat closes and the person stops breathing and awakes gasping for breath, or another condition called periodic limb movement, in which the legs or arms move involuntarily, sometimes jerking the person awake. Smolley said both conditions are treatable.

He said would temporarily prescribe a sleeping medication to help people fall asleep under some circumstances, such as after a death in the family, but in general he tries to get the insomniac to learn new behaviors or unlearn old ones.

"(Sleeping pills) are big business because there's a lot of insomnia, but I have a bias," Smolley said. "There's increasing (medical studies) that support the following the statement: Insomnia, depression, and anxiety all can be treated by behavioral therapies."

A study published late last year in the Annals of Internal Medicine compared patients who tried behavior changes with people who used sleeping pills to fall asleep. The Harvard Medical School researchers found behavioral therapy worked better than medication in a group of young adults and middle-aged adults.

An analysis earlier this year of six clinical trials also found benefits for older patients using the drug-free approach. The Cochrane Collaboration, an international group of researchers who analyze and assess medical evidence based on clinical trials, found that people 60 and older benefited from behavioral therapy.

"When the possible side effects of (sleeping pills) are considered, there is an argument to be made for clinical use of cognitive-behavioral treatments," the researchers said.

Smolley teaches his patients relaxation techniques and reminds them they can't force themselves to go to sleep.

"People have to be reminded sleep is not an Olympic sport," Smolley said. "You can't turn your mind off like a computer, but you can turn your mind on to something relaxing. Think about walking on the beach, or walking in the woods. Enjoy this fantasy and allow yourself to go to sleep."

POPULAR PRESCRIPTION SLEEP AIDS

AMBIEN, made by Sanofi-Aventis

How it works: Affects chemicals in the brain that can bring on sleep.

Side effects: Can cause dizziness, diarrhea, daytime drowsiness, memory problems.

Cautions: Recommended for short-term use, 7 to 10 days. If you take it for more than two weeks, don't stop it abruptly because you may have withdrawal symptoms. Don't drink alcohol when taking the drug.

LUNESTA, made by Sepracor

How it works: Affects chemicals in the brain that can bring on sleep.

Side effects: Can cause unpleasant taste, dizziness, daytime drowsiness, and headache.

Cautions: Can be prescribed for long-term use, although some people may become dependent on the drug. Do not drink alcohol when using the drug.

SONATA, made by Wyeth-Ayerst

How it works: Decreases the time to sleep onset. Has not been shown to increase total sleep time or decrease the number of times you awaken after falling asleep.

Side effects: Can cause drowsiness during the day, dizziness, lightheadedness, difficulty with coordination, or memory loss.

Cautions: Recommended for short-term use, 7 to 10 days. Stopping the drug after longer use may result in withdrawal symptoms. Don't drink alcohol when taking the drug.