Wake Up Call: The Dangers of Prescription Sleep Aids
Just about everyone has trouble sleeping now and then, or even endures stretches of time in which the Sand Man remains elusive. According to the National Institutes of Health, chronic insomnia equates to sleeplessness nearly every night for at least a month. Unfortunately, the culture in America subscribes to the same approach to address insomnia as it does many other disorders – take two with a glass of water. However, new research reveals some eye-opening problems are associated with the use of prescription sleep aids.
“To sleep, perchance to dream…”
This phrase originates from Hamlet’s famous “To be or not to be” soliloquy in which he hints that he is contemplating suicide to escape the burden of discovering that his father, the King of Denmark, has been murdered and that his mother has married the murderer, who happens to be his uncle. However, he gives pause for fear that not even death will bring him peace because of “what dreams may come.” Just as Hamlet suspected that there was something rotten in Denmark that permanent slumber could not avenge, you should be leery of promises that a pill can safely lull you into sleep. In fact, according to a new study, the habitual use of prescription sleep aids may increase your risk of death over a two-year period by five-fold. If that’s not enough to keep you awake at night, the study researchers also found a correlation between sleeping pills and an increased risk of cancer.
A Nightmare in Numbers
In March 2012, the New York Times reported that 60 million prescriptions for sleep aids were filled in the U.S. in 2011, an increase of 13 million from 2006 (Reference 1). Approximately 10 million Americans use some form of sleep aid each night, says Dr. Nancy Snyderman, Chief Medical Editor at NBC (Reference 2). Women appear to be more prone to pill popping to put their insomnia to bed. In fact, a 2007 National Sleep Foundation study found that a whopping 3 out of every 10 American women admit to taking a nighttime sleep aid at least a few times a week (Reference 3). It seems that women who do the most tossing and turning – and who are most likely to turn to sleeping pills – are between the ages of 40 and 59 (Reference 2).
Speed Bumps to Sleep
There are many factors that may account for insomnia, not the least of which may be the “I can do it all” syndrome that many women suffer from. The National Sleep Foundation study, dubbed “Women and Sleep,” shows that 80% of the study participants were simply too stressed to get any shuteye (Reference 3). Not surprisingly, the biggest stress-inducer is a reluctance to turn off electronic gizmos that deliver information and messages that we can’t seem to ignore any more than a ringing phone.
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Other sleep-robbers include certain medical conditions and medications, indulging in too much coffee or alcohol and – here it comes – advancing years and declining hormones. One key hormone that tends to diminish with age is melatonin, which is charged with two tasks: 1) to signal the body to prepare for sleep by lowering body temperature, and 2) to stimulate gamma-aminobutyric acid (GABA) neurotransmission, which induces sleep by promoting a state of relaxation. But, guess what? Melatonin release is triggered in response to little or no light. So, if you’re staring at your cell phone waiting for the next text message, tweet or status update to come through, the light from the gadget is like a beacon in the night that blocks your path to getting your Zzzs.
Death by Dosing to Doze?
The cohort study that has everyone buzzing, which was published in BMJ Open in February 2012, followed more than 10,000 patients prescribed sleeping pills for 2.5 years and found an increased rate of morbidity and cancer compared to other people of the same age with similar lifestyles and health status (Reference 4). However, Dr. Snyderman sheds light on the study results by pointing out its design flaws. For one thing, she says, it isn’t clear how many study participants actually filled their prescriptions or how many combined prescribed sleeping aids with other medications. Further, the study does not demonstrate an increased risk of early death or cancer as a direct cause-and-effect consequence of taking sleeping pills, only that there is a correlation between these events. In other words, if you take a sedative every night, you’re more likely to experience an accidental overdose, traffic mishap or other adverse incident than if you didn’t. (Reference 2)
And this doesn’t even begin to address the potential side effects associated with prescription sleep aids. Just take a look at a few of these side effects of ambien:
Severe Anaphylactic and Anaphylactoid Reactions:“Cases of angioedema involving the tongue, glottis or larynx have been reported in patients after taking the first or subsequent doses of sedative-hypnotics, including zolpidem. Some patients have had additional symptoms such as dyspnea, throat closing or nausea and vomiting that suggest anaphylaxis. Some patients have required medical therapy in the emergency department.”
–Abnormal Thinking and Behavioral Changes:“Abnormal thinking and behavior changes have been reported in patients treated with sedative/hypnotics, including Ambien. Some of these changes included decreased inhibition (e.g., aggressiveness and extroversion that seemed out of character), bizarre behavior, agitation and depersonalization. Visual and auditory hallucinations have been reported.
Complex behaviors such as “sleep-driving” (i.e., driving while not fully awake after ingestion of a sedative-hypnotic, with amnesia for the event) have been reported in sedative-hypnotic-naive as well as in sedative-hypnotic-experienced persons.
–Central and peripheral nervous system:Frequent: ataxia, confusion, euphoria, headache, insomnia, vertigo Infrequent: agitation, anxiety, decreased cognition, detached, difficulty concentrating, dysarthria, emotional lability, hallucination, hypoesthesia, illusion, leg cramps, migraine, nervousness, paresthesia, sleeping (after daytime dosing), speech disorder, stupor, tremor. Rare: abnormal gait, abnormal thinking, aggressive reaction, apathy, appetite increased, decreased libido, delusion, dementia, depersonalization, dysphasia, feeling strange, hypokinesia, hypotonia, hysteria, intoxicated feeling, manic reaction, neuralgia, neuritis, neuropathy, neurosis, panic attacks, paresis, personality disorder, somnambulism, suicide attempts, tetany, yawning.
The list is seemingly endless, see for yourself Ambien Side Effects
Better Ways to Bed Down
Setting the cohort study aside, statistics seem to suggest that many people, women in particular, lack sufficient downtime to balance life, work and family obligations. It’s reasonable to draw that conclusion from the fact that millions of Americans, again the majority of them women, are actively self-medicating with prescription sleeping pills just to shut down for the night. But, there are other, safer ways to invite sleep to come, such as practicing what sleep researchers and therapists refer to as proper “sleep hygiene.”
- Limit alcohol intake. Alcohol disrupts normal sleep patterns, causing more frequent periods of wakefulness and fewer periods of deep sleep. It doesn’t take getting three-sheets-to-the-wind either; habitual five-o-clock high balls, wine with dinner and subsequent nightcaps can have the same impact.
- Don’t use your bed for anything other than sleep or sex. Period.
- Adhere to a regular evening routine and consistent bedtime schedule.
- Don’t count sheep to force sleep. If you don’t fall asleep after 30 minutes, leave the bedroom and meditate, read or engage in another relaxing activity elsewhere for a while. Perhaps take a warm bath.
Consider Monoamine Precursor Therapy
Monoamine precursor therapy simply means to take advantage of certain nutrients and herbs that act as precursors to the manufacture of sedating neurotransmitters, like our friend melatonin. L-tryptophan and 5-hydroxytryptamine (5-HTP), for instance, are both involved in the synthesis of melatonin and serotonin, another “feel good” hormone. Supplementing with these nutrients is one way to trigger this cascade of chemical events; another is to eat a small potato or a piece of bread shortly before retiring for the night.
Valerian has been used for centuries to coax sleep and studies show that the extract, standardized to contain 0.8% valerenic acids, excites GABA receptors in the brain as effectively as diazepam (Valium). Other herbs proven useful in treating insomnia include passionflower, lemon balm and kava kava. Just be sure to check with your physician before self-treating a chronic sleep disorder with any supplement, especially if you take other medications to control blood pressure, cholesterol levels or symptoms of depression. Because insomnia can by a sign of an underlying medication condition, it’s also a good idea to see your doctor to rule out this possibility.
New York Times: “New Worries About Sleeping Pills”; Roni Caryn Rabin; March 12, 2012 http://well.blogs.nytimes.com/2012/03/12/new-worries-about-sleeping-pills/
Today Health: “Could Ambien Increase Your Risk of Death?” http://todayhealth.today.msnbc.msn.com/_news/2012/02/28/10529503-could-ambien-increase-your-risk-of-death
New York Times: “Sleep Medication: Mother’s New Little Helper”; Pamela Paul; November 4, 2011 http://www.nytimes.com/2011/11/06/fashion/mothers-and-sleep-medication.html
BMJ Open: “Hypnotics’ Association with Mortality or Cancer: A Matched Cohort Study”; Kripke, D. et al.; Feb 2012 http://bmjopen.bmj.com/content/2/1/e000850
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