Awakening our Knowledge of Sleeping Pills - Sedative-Hypnotics

Australian born actor, Heath Ledger, died on January 22, 2008. Many of the news reports concentrated on Heath’s struggle and growing frustration with insomnia. It’s a sentiment that many of us can relate to as we lie flat on our backs, neck muscles tensed and eyes wide awake at 3 o’clock in the morning. The National Sleep Foundation estimates that over 1/3 of the American population fights with insomnia at some point during their lifetime. That is over 99 million insomnia sufferers in the United States alone.

If you have ever tossed and turned all night long after too much Starbuck’s, then you will have a inkling as to what the insomnia sufferer goes through. But you will have to multiply the anxiety of not sleeping and the daytime fatigue by 10 to begin to really understand. It’s not hard to see how the insomniac wouldn’t try to knock himself out with pills just for one night of relief. The problem lies in finding the proper medication and dose for each individual. There is no silver bullet in pill form and increasing the dose on your own can be risky. Two pills are not always better than one. Heath may have experienced a glimmer of relief from his prescribed dose of sleeping pills. After repeated use, the dose could have lost its effect and Heath may have started to increase the dose on his own until the frustration and fatigue clouded his judgement enough to allow his desperation to take over. The result was a deadly and accidental overdose of Ambien.

When the right medication is used properly and combined with strategic changes to daily routines and activities, sleep will often return. You will fall asleep more quickly, stay asleep longer and wake up feeling a lot more refreshed. Help is available and there is no need to suffer. If you are considering taking sleeping pills read these important points:

• Sleeping pills should only be used for few weeks at a time, and in the lowest possible dose needed in order to do some good.
• The medication should only be taken after 2 or 3 poor nights of sleep. They are not meant to be taken every night.
• Consider the rate of absorption of the medication. This refers to how long does it takes the drug to start working after you have taken it. Some medications take longer to work and should therefore be taken earlier in the evening.
• Consider the medication’s half-life. This refers to how long the drug stays in your body. For example, drugs with long half-lives stay in your system longer and could still be in your body the next day. This is not uncommon in the case of sleeping pills. Some people complain of feeling worse the next day, as though they have a hangover. Do not drive your car if you feel one of these medication hangovers. Drugs with shorter half-lives on the other hand are gone from your body by the morning and therefore, do not have the same effect on daytime functioning.
• Also consider the duration of medication use. This refers to how long you will be taking the drug. Sleeping pills are for short-term use and will help only if you combine them with strategic changes to your daily routines and activities.
• Be aware of rebound insomnia. Insomnia will often come back with a vengeance when you stop taking the sleeping pill. During the first few nights without the sleeping pill, sleep gets worse. As a result, there is a greater temptation to start taking the pill again. Rebound insomnia has a greater chance of occurring in drugs with shorter half-lives. Drugs with longer half-lives remain in the body longer and thus do not cause as much rebound insomnia. Also, the higher the dosage of the drug, the greater the chance of having rebound insomnia.
• If sleeping pills are taken for longer than the recommended 2-3 weeks, another problem can arise, it is called tolerance. This means that the longer you take the drug, the less effective it can be and you end up taking a higher dosage in order to get the same effect. This can lead to addiction.
• Sleeping pills should not be taken by patients with sleep-disordered breathing, such as sleep apnea. If you do have sleep apnea, sleeping pills will only make it worse since they reduce respiratory effort and rate. In addition, they can cause the amount of oxygen in the blood to decline and this can wake you up all night long.
• Alcoholics, drug abusers, pregnant women and nursing mothers should not take sleeping pills.
• Individuals who need to be very alert when they wake up should avoid sleeping pills because of the hangover effect. This is recommended for medical doctors on call, drivers, pilots and firefighters.
• Elderly individuals should also avoid taking sleeping pills because they have a greater chance of becoming addicted. It takes longer for their bodies to get rid of sleeping pills. If sleeping pills are prescribed, they should only be prescribed in the lowest possible dose.
• Caution should also be taken when other medications are being used. Sleeping pills can interact with other drugs and cause severe side effects.
• Individuals with psychiatric problems such as depression should also avoid sleeping pills.
• If the sleeping pill causes excessive daytime sleepiness, discontinue its use.
• Never, ever mix alcohol and sleeping pills. This can be deadly!
• Always combine sleep medication with strategic changes to daily routines and activities. This is the best approach and can lead to sleep improvements that last a lot longer (Morin et al. JAMA, 1999. 281: 991-999). Ask the Sleep Coach to show you how....

A Word on Over-the-Counter Sleep Aids:
Many of the sleep aids that you can buy right off the shelf without a prescription contain antihistamines. Antihistamines are often used to treat the common cold and allergies and one of their side effects is sleepiness. As a result, many people use these medications to help them sleep. However, it is easy to build up a tolerance to antihistamines. Antihistamines also cause daytime drowsiness which can impair performance. They can also cause allergic reactions and they may not mix well with prescription medications. Taking antihistamines with alcohol can also be harmful. Like sleeping pills, antihistamines and other over-the-counter sleep aids should only be used for very short periods of time and under the advice of your medical doctor and in conjunction with strategic changes to daily routines and activities.

Thanks to Lisa Orr, BA, RPSGT for her help with this article.

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