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Sleeping Pills and Sleep

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Sleeping pills are often used as a quick fix for a sleepless night but many Americans use them for much longer than advised. Pills mainly work by causing drowsiness and “knocking us out” until the morning comes. However, we won’t always wake up refreshed – especially if we take them too late at night or double the dose.

Are sleeping pills dangerous? Do they cause “real sleep”? More and more doctors and professionals advise against using them because research keeps showing us that sleeping pills are actually bad for you. They are linked to early death, cancer, dementia, and are said to only cause sedation which is not and cannot replace the healthy natural sleep.

What do sleeping pills do to our sleep? Benefits and consequences

Sleeping pills cause people to fall asleep more quickly by making them drowsy. This drowsiness is not natural, it does not help change our inner clock (circadian rhythm), and it doesn’t let our body fall into deep stages of sleep.

Those stages are important because they ensure the feeling of refreshment by consolidating our memories, boosting the immune system, repairing damaged tissue, cleaning the brain from wasteful chemicals and a lot more. Another thing you may be missing with sleeping pills is REM sleep. Most known for vivid dreams, REM also consolidates memories and helps balance out our emotions. 

If someone has used sleeping pills for a long time, they may feel it’s impossible to sleep without them and experience withdrawal symptoms which can make falling asleep even more difficult.

Sleep problems and drugs

Image source: Consumer Reports

Side effects of sleeping pills

Research proving against the usage of sleeping pills is growing. Most common side effects are headache, constipation, dry mouth, swelling, allergies, and dizziness. These are the least problematic risks. More serious ones include the following:

  • Increased drug tolerance. People develop drug tolerance rather quickly. It is dangerous because it leads to other risks like dependence, overdose, rebound insomnia, and more.
  • Dependence. Sleeping pills tend to be addictive so many drug users start using them daily and begin relying on them too much. If you feel like you wouldn’t be able to sleep at all without your pill, you should start changing your habits right away.
  • Psychomotor impairment. The day after you take a sleeping pill you may feel hungover, slow, and unable to think and react clearly, correctly, and quickly.  This is especially the case if you took the pill too late at night and its chemicals are still running through your system.
  • Hiding the real issue. If you can’t fall asleep or stay asleep through the night, you may be dealing with other problems like stress, mental disorder, depression, or even health issues or sleep disorders like OSA (obstructive sleep apnea). As the pill only sedates you, it won’t solve any of your actual problems and could make them even worse. 
  • Rebound insomnia. When the usage of sleeping pills ends, insomnia usually comes back. This shows the nature of pills – they do not solve your problem but only postpone dealing with it. Falling asleep can be even more difficult once you ditch the pills.
  • Withdrawal. Some people experience withdrawal symptoms just like those from other drugs – trembling, nausea, sweating, delirium, irritability, hallucinations, and heart palpitations.
  • Mixing drugs. Whoever wants to take sleeping pills needs to double-check how they interact with other medications, especially other sedatives. Overlooking this can be dangerous and make other side effects worse.
  • Memory loss and suicidal thoughts. Prescription sleeping pills like benzodiazepines and non-benzodiazepines sometimes cause forgetfulness and even suicidal thoughts (which may result in suicidal actions).
  • Unusual sleep-related actions. Many have reported unusual actions from sleepwalking and sleep-eating to more serious sleep-driving. All of these actions occur while a person is sleeping. They have no memory of performing them whatsoever after they wake up.

If you have a sleep-related breathing disorder, avoid sleeping pills because they can cause death – instead of waking up to catch a breath, you may stay asleep due to hypnotics as your respiratory system fails.

Dangers of sleeping pill use

Sleeping pills can be prescribed or bought over the counter. People use them for insomnia, changing working shifts or time zones. Sleeping pills can be a quick fix for one or two nights but shouldn’t be used for longer periods of time.

One of the reasons is that we develop a tolerance for the pills so they quickly become ineffective. It means you can easily become physically and/or mentally addicted. Some people opt for a second dose in the middle of the night if the first one didn’t produce desired effects, while others stop using them for a couple of weeks only to come back to sleeping pills once their tolerance level goes down.

The first case is not too rare. This should worry us because it is extremely dangerous to take more sleeping pills than you need – these people are more hungover in the morning which makes them dangerous drivers and workers. They are at a very high risk of hurting themselves or others. Taking a double dose will increase drug tolerance even more and this may open doors to overdose and even death. Some research suggests that about a third of all drug overdose-related deaths are caused by sleeping pill misuse. 

One large overview of studies has shown scary results. It linked the use of sleeping pills with higher mortality of all causes (overdose, cancer, accidents, infections, and more). 

Daniel F. Kripke, the author of the study, has found 45 studies which all point to increased mortality among people who use hypnotic drugs. He even found that short-term use of these pills unsafe.

Nighttime deaths. Often the sleeping pill is not seen found “guilty” for nighttime deaths. Death cause is prescribed to other factors when the pill is much more likely to have caused respiratory failure.

Infection. Sleeping pills can also cause dangerous pulmonary infections, as proven on human and animal studies. Diazepam, for instance, worsens infection through GABA receptors – the very receptors it binds with to make us sleepy. This infection is potentially deadly and doctors rarely ask if the patient is using a sleeping pill when they find pulmonary, liver, or pancreatic infection.

Cancer. Many in vitro, animal, and human studies demonstrated that hypnotics use causes cancer. Drug agents like zopiclone, zaleplon, and ramelteon are clastogenic. This means they are mutagens which cause damage to chromosomes which further leads to abnormal cell activity and cancer. Some cells in our body are killed by clastogenic substances, but if they survive, they may become cancerous.

What is the safe dose? Scientists don’t know. Every drug affects every person slightly differently, depending on age, body mass, gender, genetics, and overall health. So is the sleeping pill you’re about to take safe for you personally? We don’t know. If you are a tiny elderly woman, you’re likely to suffer much stronger consequences than a young and strong male, but that may not be the case, because there are also factors of genetics and substance abuse. All of that makes too many factors that drug producers can’t take into consideration. Most deaths related to sleeping pills also include factors like other sedatives, opiates, alcohol, and obesity.

How we use sleeping pills vs how we should be using them

Sleeping pills should be used exactly as prescribed by your doctor. For OTC (over the counter) drugs, do exactly as indicated on the label. Some pills were made to cause sleepiness while others should help you remain asleep. 

You will be prescribed either shorter-lasting or longer-lasting pills, depending on the type of your insomnia. If a drug you get is classified as “weak”, do not assume it has a poor or weak effect. 

According to Michael J. Sateia, MD, Professor Emeritus of psychiatry and sleep medicine at The Geisel School of Medicine at Dartmouth, this classification merely shows the amount of data that’s available. He warns that evidence supporting trial studies is not certain. Dr. Sateia also reminds us that those studies are usually funded by drug companies, hinting that it wouldn’t be in the companies’ best interest to reveal undesirable results about their product.

Drowsiness after drug use

What people who used a sleeping drug reported. Image source: Consumer Reports

Taking sleeping pills too late at night

If you are taking your sleeping pill at 3 am, you are not doing yourself a service. A study published in the Journal of Clinical Sleep Medicine has shown us that about 20% of people who take sleeping pills to stay asleep actually take them in the middle of the night after they wake up. For half of them, this was the second time they had taken a pill that night. 

So about a fifth of those who use sleeping pills use them incorrectly and every ninth person took two pills per night. 

The first problem here is that these people wake up in the morning with too much of the drug in their system. Scientists warn about this because taking pills in the middle of the night causes very bad impairment in thinking and physical abilities. The second problem is that this behavior speeds up tolerance development and worsens other risks and side effects. 

If you still keep waking up after you already took a pill, maybe sleeping pills are simply not effective for your problem and you should seek other solutions (read on to find them).

How to use sleeping pills safely

In case you decide to take sleeping pills or believe you can’t avoid them, make sure to follow basic safety rules and not overuse the medication.

  • Leave about 8 hours of sleep time after taking the pill. If you don’t have so much time, it’s better to skip the pill. Sure, morning grogginess can be pretty bad if you’ve had about three hours of sleep, but it is much worse if you are sedated by a hypnotic drug on top of that.
  • One dose per night. Your prescribing doctor has probably told you to use only one pill per night, but as research shows us, many disobey this rule. Sleeping pills are already not good for your health, so try not to make that worse by doubling the dose.
  • Don’t mix pills with risky substances. This includes alcohol, other sedatives, and other sleeping pills. Check what kinds of food, drink, and medications you are allowed to take when you are on your pill. Read the package carefully.
  • Never drive or do other dangerous and complex tasks after a sleeping pill. We’ve already mentioned how it affects attention and reflexes, and this effect can vary from one person to another. 
  • Use sleeping pills rarely. Frequent usage increases tolerance and dependency risk.
  • Check if the pill can have an adverse effect on your existing medical condition. Sleeping pills may be more dangerous for some people.

Are sleeping pills over-prescribed?

Whether a sleeping pill will be prescribed depends on the doctor. Some studies show that sleeping pills are often prescribed even to people who don’t have insomnia or short sleep. About a half of people who take the pill about 20 times a month do not actually have insomnia, but other problems. Some nursing homes seem to ignore the numerous drawbacks of sleeping pills and keep giving them to the elderly, considering addiction just a minor problem. It is proven that sleeping pills (or any other drugs) do not shift the circadian rhythm, so people who have jet lag should not take them, especially cabin crews responsible for a safe flight.

Luckily, in 2016, the American College of Pediatricians has recommended Cognitive Behavioral Therapy for Insomnia (CBT-I) as the first-line treatment for chronic insomnia.

Is CBT-I a better solution than sleeping pills?

It surely is. Matthew Walker, a famous sleep researcher, is one of the strongest supporters of this therapy. One of his arguments is the fact that after we stop using sleeping pills, our insomnia returns, sometimes worse. But with CBT-I, therapy lasts for two to three weeks and the results remain for about a year. Free of drugs, healthy, and natural.

What is Cognitive Behavioral Therapy for Insomnia?

It is a type of treatment that helps patients develop healthy sleep habits. This is done by teaching them about good and bad practices, desirable and undesirable behaviors. A patient slowly replaces bad habits with good ones through stimulus control (no exciting activities at bedtime), sleep restriction (sleep time is defined and strictly respected, even if it’s impossible to fall asleep on time at first – this helps slowly adjust the biological clock).

Types of sleeping pills

This is a table of sleeping pill types with how they work, effects, and side effects. It was in part taken from WebMD.

DrugHow It WorksDuration of EffectsSide Effects
DiphenhydramineActs on histamine receptors in the brain to cause drowsiness.4-6 hours (sleepiness may last longer)Daytime sleepiness; confusion and difficulty urinating in older people.
Selective GABA MedicinesAmbien (zolpidem tartrate)Ambien CR (zolpidem tartrate extended release)Lunesta (eszopiclone)Sonata (zaleplon)Binds to a specific type of GABA receptor in the brain.6-8 hoursUsually few. Memory disturbances, hallucinations, behavior changes possible.
Sleep-Wake cycle ModifiersRozerem (ramelteon)Stimulates melatonin receptors in the brain area that controls the sleep-wake cycle.4-6 hoursHeadache, drowsiness, dizziness. Uncommonly, problems with sex drive. Loss of menses or problems getting pregnant.
BenzodiazepinesAtivan (lorazepam)Halcion (triazolam)Restoril (temazepam)Valium (diazepam)Xanax (alprazolam)Binds to general GABA receptors in the brain.Varies (from 4 hours to more than 12)Sedation, loss of muscle coordination, dizziness, habit-forming.
Tricyclic AntidepressantsAdapin (doxepin)Aventyl (nortriptyline)Elavil (amitriptyline)Pamelor (nortriptyline)Sinequan (doxepin)Trazodone (desyrel)Binds to multiple brain receptors including acetylcholine; sedating.Not well studiedLow at usual doses for insomnia. Dizziness, blurry vision, difficulty urinating, cardiac arrhythmias possible. Trazodone can cause prolonged, painful erections.

Additional resources

  1. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890308/
  2. Hypnotics’ association with mortality or cancer: a matched cohort study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293137/
  3. ACP Recommends Cognitive Behavioral Therapy as Initial Treatment for Chronic Insomnia https://www.acponline.org/acp-newsroom/acp-recommends-cognitive-behavioral-therapy-as-initial-treatment-for-chronic-insomnia
  4. Sleeping pills https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1701519/
  5.  The sleep-wake cycle and sleeping pills https://www.ncbi.nlm.nih.gov/pubmed/17049955 
  6. Surprising View of Insomnia and Sleeping Pills https://academic.oup.com/sleep/article/36/8/1127/2453902
  7. “And mostly they have a need for sleeping pills”: Physicians’ views on treatment of sleep disorders with drugs in nursing homes https://www.sciencedirect.com/science/article/abs/pii/S0890406512000564
  8. Middle-of-the-Night Hypnotic Use in a Large National Health Plan http://jcsm.aasm.org/ViewAbstract.aspx?pid=29029

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

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