What about sleeping pills

Everyone in a lifetime will occasional have sleepless nights.

It can happen due to many things like stress, pain, drinking to much coffee, being in love. It’s something natural.

But when you frequently have problems falling asleep, maintaining sleep, or experience nonrestorative sleep, often for no apparent reason you may be suffering from chronic insomnia.

It’s a bad cycle. The factor that caused insomnia in the first place does not disappear, not sleeping hinders body and mind rest, generates more stress and more concerns about not falling asleep which may worsen the insomnia problems.

This is when people look for help and when sleeping pills are the solution.

It’s a common problem that may be temporary or chronic. As many as one in ten Americans have chronic insomnia, and at least one in four has difficulty sleeping sometimes.

Sleeping pills always existed in the form of herbs and teas that induce sleep but the revolution started when pharmacology discovered benzodiazepines which replaced the use of barbiturates.

Benzodiazepines and barbiturates works on neurons with GABA receptors. GABA is the major inhibitory neurotransmitter of the brain and that’s why these drugs are also tranquilisers and anti-anxiety.

Barbiturates activate GABA receptors directly which explain why they are so dangerous. Its effect can change from sedation, sleep, general anesthesia, coma and dead (mostly because we stop breeding) with just some differences in the dosage. Benzodiazepines also work on GABA receptor but not directly as barbiturates, they just make GABA receptor more likely to link endogenous GABA. They can also cause anesthesia, coma and dead but the dosage must be enormously higher and most the time that happens there are associations with other nervous system depressors like alcohool. This is why benzodiazepines are considered a safe drug; its action is always limited by endogenous GABA. Examples of this group are triazolam, temazepam and nitrazepam but other names are more known like Valium®, Librium®, Halcion®, and Xanax®.

A new generation of sleeping pills appeared and includes zopiclone and zolpidem but its action is almost the same as benzodiazepines differing only in the time they are active. The new generation works faster which prevent side effects in the morning like drowsiness or headaches.

So, doctors now have safe drugs, they work, they are easy to prescribe, pharmacology industry does a lot of marketing around them, if you go to a doctor saying you can’t sleep what is more likely to happen?

Probably he will give you a benzodiazepine and may be that’s the reason why these drugs are top sellers and why there are so many variations on the basic benzodiazepine theme.

When taken as directed for short periods (no more than two weeks), they might work breaking out the bad cycle that worsens the insomnia. One or two nights under benzodiazepine effect can work to regularize the sleep.

But the insomnia has always a cause, and if the patient does not find it, the insomnia will come back and the patient may feel the only thing that can help him is the pill that worked the other time. This feeling supported by the doctor believes that the pill is safe and the best for the patient problem creates chronic benzodiazepine users. It develops a conditioned reflex – “I can only sleep well if I take the pill”, that tries to artificially create good night’s sleep.

Chronic benzodiazepine consumption is a polemic issue because there is no clear evidence of a therapeutic use longer than 4 weeks but there are evidence that the abuse of these drugs are associated with a risk of tolerance and addiction. Other side effects are being associated to these drugs especially in the eldery individuals. After all, benzodiazepines are not that safe.

Tolerance to the hypnotic effects (sleep induction) develops quickly which makes long-term management of insomnia difficult. Patients typically notice relief of insomnia initially, followed by a gradual loss of efficacy but many patients keep taking these pills because they claim a (subjective) positive effect without raising the dose.

After a few months using this drugs if the patient abruptly stops taking them some withdraw effects should occur, that’s why stop taking benzodiazepine should be done by gradually reducing dosage and with professional help.

What about alternatives to sleeping pills?

There is evidence that behavioural treatment works as well as the pills in the short term and even better in the intermediate and long term.

These treatments include stimulus control, relaxation techniques, sleep hygiene and intend to regularize sleeping habits. I recommend you to read this for more details about these treatments.

Despite this evidence, it is clear that these treatments are underused, not only in the sleep field, but also for anxiety and depression.

I believe it’s important to understand that some changes in our life can affect our sleep as many other aspects of our health, the pills will help but only with proper understanding of how they work and what is its intention. In the end the patients are the ones who solve their problems, all the pills are just a part of the solution, not the whole solution..

More about this:

http://www.doitnow.org/pages/134.html

http://www.aafp.org/afp/20000401/2121.html

http://www.mayoclinic.com/health/sleeping-pills/SL00010

http://web4health.info/en/answers/sleep-benzo-chronic.htm

http://psychiatry.jwatch.org/cgi/content/full/2006/1229/3#