Who’s Using All Those Sleeping Pills? (10/3/12)
So Who Is Using Sleeping Pills?
Lots of people – especially people not prescribed them. According to the Royal Pharmaceutical Society (reported in the BBC), a full third of adult Britons complain of insomnia.
Fully half of these insomniacs take prescription sleeping pills their doctors don’t know about. Thirty percent take them for at least one month. About 14% took them for six months or more.
Based on recent surveys, American use may be quite similar.
What’s The Problem?
Imbibing prescription pills not obtained prescribed for you is illegal. You don’t want to know what might happen to the people who “give” them to you.
And there is the problem of increased mortality. A recent large scale study by Dan Kripke and colleagues – based on electronic medical records – found a five fold increase in death rate for people who took sleeping pills regularly. There were increased deaths in several categories, including cancer deaths.
Other studies don’t show such a marked increase, but good data from Sweden show deaths still rise appreciably.
What Is About Sleeping Pills that Kills People?
Accidents, falls, increased confusion are universally accepted reasons for increased mortality. Some think sleeping pills also increase cardiovascular deaths – though the mechanism is unclear.
What Other Problems Can Sleeping Pills Worsen?
Memory, focus, cognition, judgement. Some people lost their Alzheimer’s diagnoses once their sleeping pill use was stopped.
And then there sleepwalking – really weird sleepwalking. One Canadian driver went to court to fight his second driving under the influence arrest , following an accident where he hit several cars. He claimed ambien (zolpidem) provoked him to pull a bottle of vodka out of his fridge and drink the whole lot, causing his unconscious ramble.
Recently a patient of mine took ambien for a few days. She couldn’t understand why she was waking up with hamburger between her teeth. She’s a vegetarian.
It turns out she had devoured her husband’s lunch – stashed in the refrigerator – while asleep.
What Usually Causes the Insomnia that Makes People Want to Take Sleeping Pills?
The list is very long. These days the increasingly problematic items include stress, job stress, the economy, finances, family fights and lack of employment. Virtually any chronic medical condition can produce insomnia, as can most drugs. Alcohol causes some horrific insomnias; tobacco wakes people up through the night (yes, nicotine routinely withdrawal occurs during sleep); lots of anti-hypertensive drugs play havoc with sleep.
However, insomnia clinics usually see a large number of people with sleep apnea, depression, anxiety disorders, and interestingly, sleeping pill use as precipitants of insomnia.
Do People Take Non-Prescription Pills to Sleep?
All the time. Probably more take OTC items like melatonin, valerian, Benadryl (diphenhydramine), tryptophan than anything like prescription use. There are also hundreds of “mood relaxation drinks” also marketed as sleep aids.
Efficacy for the many different relaxation drinks out on the market is generally unknown. Many clinicians feel the relaxation drink “cure” is useless or worse.
What’s the Problem With Using A Pill to Sleep?
Besides mortality and the problems noted above, sleep is about conditioning. When people get used to the pattern of pill=sleep, they often become habituated to taking a pill in order to sleep. The result becomes No pill = insomnia – problem that can last for years.
What Are the Alternatives to Sleeping Pills?
Numerous and well studied results come from simple, repeatable sleep behaviors prior to bed – putting out the clothes for the next day, flossing and brushing, lowering the lights, pulling out that copy of David Copperfield you’ve been dying to read for 36 years. Insomnia clinics often use sleep restriction, timed light, timed exercise, cognitive-behavioral techniques, and myriad rest-relaxation techniques to get people to sleep naturally.
Lots of people are taking prescription sleeping pills – illegally and often not very intelligently. They don’t know all the bad things that “mommy’s little helper” can do to their bodies and brains.
In a society where “every moment counts” and jobs are stressful and hard to find, the problem appears to be rising. And there are many, many effective non-pharmacologic ways to help people sleep.
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