October 25

Insomnia and Sleeping Pills

Did you know that insomnia affects 60% of the adult population? Given how common it is, it’s odd that there is very little funding granted for research on this condition. Medical doctors are not trained on how to treat insomnia other than to prescribe sleeping pills.

How well do they work?

Sleeping pills tend not to be very effective. Studies show that they work a little better than placebo: They help you to fall asleep about 10 minutes faster and help you to stay asleep about 10 minutes longer, but they don’t improve sleep quality. Also, they work only while you take them. Once you stop taking them, the problem persists.

Sleeping pills work only for a short term — about six weeks. After that, you’re taking a placebo, meaning that they’re working only because you think they are, unless you take a higher dose. Continued use at higher and higher doses makes you dependent on them because you begin to think that you need one in order to sleep.

What are their side effects?

Sleeping pills have unpleasant side effects. They can make you feel sleepy during the day (hangover effect), and cause short-term memory loss, headaches, nausea, dizziness, and impaired coordination. This is especially true for the elderly because they have a slower metabolism and are more sensitive to the side effects of sleeping pills. In fact, the use of sleeping pills is a strong predictor of nursing home placement among seniors because

  • sleeping pills increase the risk of falls and fractures due to impaired coordination
  • their side effects — confusion, apathy, amnesia, and daytime drowsiness — mimic symptoms of dementia and Alzheimer’s disease

If you have any elderly loved ones on sleeping pills, find out if they really need to be on them and look into weaning them off, if possible. You’ll probably notice that their cognitive function improves as a result.

But I can’t sleep unless I take a sleeping pill.

If you absolutely must take a sleeping pill in order to sleep, here are a few guidelines:

  • Avoid the older benzodiazepenes: Restoril, Dalmane, Xanax, Ativan, and Klonopin. These drugs give users a hangover effect and are habit forming.
  • Consider switching to low-dose antidepressants, such as Remeron or Trazodone. Even though their use is 0ff label (there’s no evidence that they work for insomnia), they have fewer side effects than the older sleeping pills: They don’t cause dependence or rebound insomnia, and they don’t affect deep sleep.

In a later blog post, I will be writing about ways to overcome insomnia through lifestyle changes, so stay tuned!

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