Are sleeping pills safe for long-term use. What are the common side effects of sleeping medications. How do different types of sleep aids work. Can sleeping pills lead to dependency or addiction. What are natural alternatives to prescription sleep medications.

Understanding Different Types of Sleeping Pills

Sleeping pills, also known as sedative hypnotics, are medications designed to help individuals fall asleep or stay asleep. They come in various forms, each with its own mechanism of action and potential side effects. Let’s explore the main categories:

Benzodiazepines

Benzodiazepines are a class of drugs that act on the central nervous system to produce a calming effect. Examples include:

• Ativan (lorazepam)
• Librium (chlordiazepoxide)
• Valium (diazepam)
• Xanax (alprazolam)

While effective for short-term use, benzodiazepines can be habit-forming and may cause memory and attention issues. They are generally not recommended for long-term treatment of sleep problems.

Barbiturates

Barbiturates are another group of sedative-hypnotic drugs that depress the central nervous system. These medications are rarely prescribed for sleep issues due to their high risk of overdose and potential for addiction. They are more commonly used in anesthesia.

Newer Sleep Medications

More recent sleep aids work by targeting specific receptors in the brain. Some examples include:

• Ambien (zolpidem)
• Lunesta (eszopiclone)
• Sonata (zaleplon)

These medications are generally considered less habit-forming than benzodiazepines, but they can still lead to physical dependence over time.

Alternative Mechanisms

Some sleep medications work through different pathways:

• Rozerem (ramelteon): Affects melatonin receptors and is non-addictive
• Belsomra (suvorexant) and Quviviq (daridorexant): Target orexin, a brain chemical involved in wakefulness
• Silenor (doxepin): A low-dose antidepressant that can improve sleep without addiction potential

Common Side Effects of Sleeping Pills

While sleeping pills can provide short-term relief for insomnia, they often come with a range of side effects. It’s important to be aware of these potential issues before starting any sleep medication:

Physical Side Effects

• Dizziness and balance problems
• Daytime drowsiness
• Dry mouth or throat
• Headache
• Gastrointestinal issues (constipation, diarrhea, stomach pain)
• Burning or tingling sensations in extremities
• Weakness
• Uncontrollable shaking of body parts

Cognitive and Behavioral Side Effects

• Mental slowing
• Attention and memory problems
• Unusual dreams
• Changes in appetite
• Impaired performance the next day

Do these side effects occur in everyone who takes sleeping pills? No, the occurrence and severity of side effects can vary greatly between individuals. It’s often impossible to predict how a person will react to a specific sleep medication until they try it.

Sleeping Pills and Special Populations

Certain groups of people may be at higher risk for adverse effects from sleeping pills. Let’s examine some of these special populations:

Older Adults and Sleep Medications

For individuals aged 65 and older, experts generally advise against using sleep aids, including over-the-counter drugs and newer “Z” drugs like Lunesta, Sonata, and Ambien. Why is this the case?

• Increased sensitivity: Older adults tend to be more sensitive to the effects of sleep medications.
• Prolonged action: These drugs often stay in the system longer in older individuals, leading to daytime drowsiness.
• Cognitive effects: Confusion and memory problems are more pronounced in this age group.
• Physical risks: The sedative effects can increase the risk of falls, fractures, and accidents.

How do over-the-counter sleep aids affect older adults? Many can cause dry mouth, constipation, and urinary retention, which can be particularly problematic for seniors.

People with Respiratory Conditions

Individuals with certain lung conditions such as asthma, emphysema, or chronic obstructive pulmonary disease (COPD) should be cautious when considering sleeping pills. These medications can interfere with normal breathing patterns and potentially exacerbate respiratory issues.

Complex Side Effects and Risks of Sleeping Pills

Beyond the common side effects, some sleeping pills can lead to more complex and potentially dangerous issues:

Parasomnias

Parasomnias are unusual behaviors that occur during sleep. Some sleeping pills, particularly those in the “Z” drug category, have been associated with complex sleep behaviors such as:

• Sleep-walking
• Sleep-driving
• Sleep-eating
• Engaging in other activities while not fully awake

These behaviors can be extremely dangerous, as the individual may have no recollection of their actions upon waking.

Allergic Reactions

While rare, some people may experience allergic reactions to sleeping pills. Symptoms of an allergic reaction can include:

• Rash or hives
• Itching
• Swelling of the face, lips, tongue, or throat
• Difficulty breathing

If you experience any of these symptoms after taking a sleeping pill, it’s crucial to seek immediate medical attention.

Drug Interactions

Sleeping pills can interact with other medications, potentially leading to increased side effects or reduced effectiveness of either drug. It’s essential to inform your healthcare provider about all medications you’re taking, including over-the-counter drugs and supplements.

The Dangers of Combining Sleeping Pills and Alcohol

Mixing sleeping pills with alcohol can have severe consequences. Both substances depress the central nervous system, and their combined effect can be dangerously amplified.

Potential Risks of Combining Sleeping Pills and Alcohol

• Excessive sedation
• Impaired motor control
• Slowed or irregular breathing
• Memory problems
• Increased risk of overdose
• Unusual behavior

Can the combination of alcohol and sleeping pills be fatal? In severe cases, yes. The combined depressant effects can lead to respiratory depression, which can be life-threatening.

Long-term Consequences

Regular use of both alcohol and sleeping pills can lead to increased tolerance to both substances, potentially fueling a cycle of increased use and dependency.

Dependency and Addiction Risks of Sleeping Pills

While sleeping pills can be effective for short-term use, they carry a risk of dependency and addiction, especially when used long-term.

Physical Dependence

Physical dependence occurs when the body becomes accustomed to the presence of the drug. This can lead to:

• Tolerance: Needing higher doses to achieve the same effect
• Withdrawal symptoms when stopping the medication

Psychological Dependence

Some individuals may develop a psychological reliance on sleeping pills, believing they cannot sleep without them. This can lead to anxiety about sleeping without medication and perpetuate the cycle of use.

Signs of Sleeping Pill Addiction

• Taking higher doses than prescribed
• Using the medication for longer than recommended
• Experiencing cravings for the drug
• Continuing use despite negative consequences
• Attempting to obtain the medication through multiple doctors or illegal means

How can one safely discontinue sleeping pills? It’s crucial to work with a healthcare provider to develop a tapering plan. Abruptly stopping these medications can lead to rebound insomnia and other withdrawal symptoms.

Alternatives to Sleeping Pills

Given the potential risks and side effects of sleeping pills, many individuals seek alternative methods to improve their sleep. Here are some evidence-based approaches:

Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I is considered the gold standard for treating chronic insomnia. This approach includes:

• Sleep restriction therapy
• Stimulus control
• Cognitive restructuring
• Relaxation techniques

How effective is CBT-I compared to sleeping pills? Studies have shown that CBT-I can be as effective as medication for short-term treatment and more effective in the long term, with fewer side effects.

Sleep Hygiene Improvements

Implementing good sleep hygiene practices can significantly improve sleep quality:

• Maintaining a consistent sleep schedule
• Creating a relaxing bedtime routine
• Optimizing the sleep environment (dark, quiet, cool)
• Limiting exposure to screens before bedtime
• Avoiding caffeine, alcohol, and large meals close to bedtime

Natural Supplements

Some individuals find relief with natural sleep aids, although it’s important to note that these should still be used under medical supervision:

• Melatonin
• Valerian root
• Magnesium
• Lavender

Are natural sleep aids safer than prescription sleeping pills? While they generally have fewer side effects, natural supplements can still interact with other medications and may not be suitable for everyone.

Lifestyle Changes

Addressing underlying lifestyle factors can often improve sleep:

• Regular exercise (but not too close to bedtime)
• Stress reduction techniques (meditation, yoga, deep breathing)
• Managing underlying health conditions
• Addressing sleep disorders like sleep apnea

When to Seek Professional Help for Sleep Issues

While occasional sleep problems are common, persistent insomnia can significantly impact quality of life and overall health. It’s important to know when to seek professional help:

Signs It’s Time to Consult a Sleep Specialist

• Difficulty falling asleep or staying asleep for more than a month
• Daytime fatigue that interferes with daily activities
• Loud snoring or gasping during sleep (potential signs of sleep apnea)
• Restless legs or periodic limb movements during sleep
• Sleep problems associated with pain or other medical conditions

What can you expect from a sleep specialist consultation? A sleep specialist may recommend:

• A comprehensive sleep history assessment
• Sleep diary tracking
• Sleep studies to diagnose underlying disorders
• Personalized treatment plans that may include behavioral therapies, lifestyle changes, or appropriate use of medications

The Importance of Addressing Underlying Causes

Often, sleep problems are symptoms of other issues. A healthcare provider can help identify and treat underlying causes such as:

• Depression or anxiety
• Chronic pain conditions
• Hormonal imbalances
• Neurological disorders
• Medication side effects

By addressing these root causes, many individuals find improvement in their sleep without relying on sleeping pills.

The Future of Sleep Medicine

As our understanding of sleep biology advances, new approaches to treating sleep disorders are emerging:

Targeted Therapies

Researchers are developing more precise medications that target specific aspects of sleep regulation with fewer side effects. These include:

• Orexin receptor antagonists
• Melatonin receptor agonists
• Drugs targeting specific neurotransmitters involved in sleep-wake cycles

Personalized Medicine

Advances in genetic testing and biomarker identification may allow for more personalized treatment approaches, helping to predict which therapies will be most effective for individual patients.

Technology-Assisted Sleep Improvement

Emerging technologies are playing an increasing role in sleep medicine:

• Wearable devices for sleep tracking and intervention
• Smart home integrations for optimal sleep environments
• Virtual reality applications for relaxation and cognitive behavioral therapy

How might these advancements change the landscape of sleep medicine? As these technologies and treatments develop, we may see a shift away from traditional sleeping pills towards more targeted, personalized, and holistic approaches to managing sleep disorders.

In conclusion, while sleeping pills can provide short-term relief for insomnia, they come with significant risks and side effects. Understanding these potential issues is crucial for making informed decisions about sleep treatment. For many individuals, non-pharmacological approaches such as cognitive behavioral therapy, lifestyle changes, and addressing underlying health issues may provide safer and more sustainable solutions for improving sleep quality. As sleep medicine continues to advance, we can look forward to more effective and personalized treatments that prioritize long-term health and well-being.

Common and Potentially Harmful Side Effects

Written by Debra Fulghum Bruce, PhD

• What Are Sleeping Pills?
• What Are the Side Effects of Sleeping Pills?
• Sleeping Pills and Older Adults
• Are There More Complex Sleeping Pill Side Effects?
• Can I Be Allergic to Sleeping Pills?
• When Do I Take a Sleeping Pill?
• Is It Dangerous to Combine Sleeping Pills and Alcohol?
• Can I Become Dependent on Sleeping Pills?
• More

Between a third and half of Americans have insomnia and complain of poor sleep. Perhaps you’re one of them. If so, you may be considering taking a sleeping pill.

A sleeping pill can help your sleep problems for the short term. But it’s important to understand everything you need to know about sleeping pills. That includes knowing about sleeping pill side effects. When you do, you can avoid misusing these sedatives.

Most sleeping pills are classified as “sedative hypnotics. ” That’s a specific class of drugs used to go to sleep or stay asleep. Sedative hypnotics include benzodiazepines, barbiturates, and various hypnotics.

Benzodiazepines such as Ativan, Librium, Valium, and Xanax are anti-anxiety medications. They also increase drowsiness and help people sleep. Halcion is an older benzodiazepine sedative-hypnotic medicine that has largely been replaced by newer medicines. While these drugs may be useful for the short term, all benzodiazepines are potentially addictive and can cause problems with memory and attention. They are usually not recommended for long-term treatment of sleeping problems.

Barbiturates, another group of drugs in this sedative-hypnotic class, depress the central nervous system and can cause sedation. Short- or long-acting barbiturates are prescribed as sedatives or sleeping pills. But more commonly, these hypnotic drugs are limited to use as anesthesia. They can be fatal in overdose.

Newer medications help you fall asleep faster. Some of these sleep-inducing drugs, which bind to the same receptors in the brain as do benzodiazepines, include Ambien, Lunesta, and Sonata. They are somewhat less likely than benzodiazepines to be habit-forming, but over time can still sometimes cause physical dependence. They can work quickly to increase drowsiness and sleep. Another sleep aid, called Rozerem, acts differently from other sleep medicines. It affects a brain hormone called melatonin, and it’s not addictive. Belsomra and Quviviq are unique sleep aids that affects a brain chemical called orexin and is not addictive. Another sleep medicine that is not addictive, Silenor, is a low-dose form of the tricyclic antidepressant doxepin.

Like most medications, sleeping pills have side effects. You won’t know, though, whether you will have side effects with a particular sleeping pill until you try it.

Your doctor may be able to tell you about some side effects if you have asthma or other health conditions. Sleeping pills can interfere with normal breathing and can be dangerous in people who have certain chronic lung problems such as asthma , emphysema, or forms of chronic obstructive pulmonary disease (COPD).

Common side effects of prescription sleeping pills such as Ambien, Halcion, Lunesta, Rozerem, and Sonata include:

• Burning or tingling in the hands, arms, feet, or legs
• Changes in appetite
• Constipation
• Diarrhea
• Balance problems
• Dizziness
• Daytime drowsiness
• Dry mouth or throat
• Gas
• Headache
• Heartburn
• Impairment the next day
• Mental slowing or problems with attention or memory
• Stomach pain or tenderness
• Uncontrollable shaking of a part of the body
• Unusual dreams
• Weakness

It’s important to be aware of possible sleeping pill side effects so you can stop the drug and call your doctor immediately to avoid a more serious health problem.

If you’re 65 or older, experts suggest that you avoid all sleep aids. This includes over-the-counter drugs and the newer “Z” drugs like eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien).

Compared to younger people, older adults have a greater chance of health problems on sleep meds. When you’re older, sleeping pills tend to stay in your system longer. Drowsiness can last into the day after you’ve taken them. Confusion and memory problems are also a known side effect. For older adults, this could result in falls, broken hips, and car accidents.

Other symptoms of some over-the-counter sleep medications can be especially hard for older adults to handle. Your mouth may be dry. You may also be constipated and find it hard to pee.

Before you decide to take sleeping pills, talk to your doctor. They may recommend a medical exam to help you figure out the cause of your sleep problems, like depression, anxiety, or a sleep disorder.  Your doctor will also suggest ways to treat sleeplessness without drugs.

Some sleeping pills have potentially harmful side effects, including parasomnias. Parasomnias are movements, behaviors, and actions over which you have no control, like sleepwalking. During a parasomnia, you are asleep and unaware of what is happening.

Parasomnias with sleeping pills are complex sleep behaviors and may include sleep eating, making phone calls, or having sex while in a sleep state. Sleep driving, which is driving while not fully awake, is another serious sleeping pill side effect. Though rare, parasomnias are difficult to detect once the medication takes effect.

Product labels for sedative-hypnotic medicines include language about the potential risks of taking a sleeping pill. Because complex sleep behaviors are more likely to occur if you increase the dosage of a sleeping pill, take only what your doctor prescribes — no more.

Yes. People can have an allergic reaction to any medicine, which could be related to either the active ingredient of the medicine itself or to any of its inactive ingredients (such as dyes, binders or coatings). People who have an allergic reaction to a specific sleeping pill should avoid it. It’s important to talk to your doctor at the first sign of these serious side effects, including:

• Blurred vision or any other problems with your sight
• Chest pain
• Difficulty breathing or swallowing
• Feeling that the throat is closing
• Hives
• Hoarseness
• Itching
• Nausea
• Pounding heartbeat
• Rash
• Shortness of breath
• Swelling of the eyes, face, lips, tongue, or throat
• Vomiting

In addition, a serious — even deadly — side effect of any medicine someone is allergic to is anaphylaxis. Anaphylaxis is an acute allergic reaction. Another possible effect is angioedema, which is severe facial swelling. Again, discuss these possibilities with your doctor if you are at risk of allergic reactions.

It’s usually recommended that you take the sleeping pill right before your desired bedtime. Read your doctor’s instructions on the sleeping pill prescription label. The instructions have specific information regarding your medication. In addition, always allow ample time to sleep before you take a sleeping pill.

Yes. Mixing alcohol and sleeping pills can have additive sedating effects from both drugs, and the combination can cause someone to stop breathing, which could cause death. Sleeping pill labels warn against using alcohol while taking the drug.

Also, you should not eat grapefruit or drink grapefruit juice while taking some sleeping pills. Grapefruit increases the amount of the drug absorbed into your bloodstream and how long it stays in the body. That can cause over-sedation.

For short-term insomnia, your doctor may prescribe sleeping pills for several weeks. Yet after regular use for a longer period, some sleeping pills such as benzodiazepines or benzodiazepine agonists such as zolpidem or eszopiclone may stop working as you build a tolerance to the medication. (However, tolerance has not been shown with non-habit-forming sleeping pills like Belsomra, Rozerem, or Silenor.) You may also become psychologically dependent on the medicine. Then the idea of going to sleep without it will make you anxious.

Without the sleeping pill, you might find it difficult to sleep. If that happens, it could be a sign of a physical or emotional dependence or both. Some studies show that long-term use of sleeping pills actually interferes with sleep. The best way to avoid developing a physical or emotional dependence on sleeping pills is to follow your doctor’s instructions and stop taking the drug when recommended.

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Common and Potentially Harmful Side Effects

Written by Debra Fulghum Bruce, PhD

• What Are Sleeping Pills?
• What Are the Side Effects of Sleeping Pills?
• Sleeping Pills and Older Adults
• Are There More Complex Sleeping Pill Side Effects?
• Can I Be Allergic to Sleeping Pills?
• When Do I Take a Sleeping Pill?
• Is It Dangerous to Combine Sleeping Pills and Alcohol?
• Can I Become Dependent on Sleeping Pills?
• More

Between a third and half of Americans have insomnia and complain of poor sleep. Perhaps you’re one of them. If so, you may be considering taking a sleeping pill.

A sleeping pill can help your sleep problems for the short term. But it’s important to understand everything you need to know about sleeping pills. That includes knowing about sleeping pill side effects. When you do, you can avoid misusing these sedatives.

Most sleeping pills are classified as “sedative hypnotics.” That’s a specific class of drugs used to go to sleep or stay asleep. Sedative hypnotics include benzodiazepines, barbiturates, and various hypnotics.

Benzodiazepines such as Ativan, Librium, Valium, and Xanax are anti-anxiety medications. They also increase drowsiness and help people sleep. Halcion is an older benzodiazepine sedative-hypnotic medicine that has largely been replaced by newer medicines. While these drugs may be useful for the short term, all benzodiazepines are potentially addictive and can cause problems with memory and attention. They are usually not recommended for long-term treatment of sleeping problems.

Barbiturates, another group of drugs in this sedative-hypnotic class, depress the central nervous system and can cause sedation. Short- or long-acting barbiturates are prescribed as sedatives or sleeping pills. But more commonly, these hypnotic drugs are limited to use as anesthesia. They can be fatal in overdose.

Newer medications help you fall asleep faster. Some of these sleep-inducing drugs, which bind to the same receptors in the brain as do benzodiazepines, include Ambien, Lunesta, and Sonata. They are somewhat less likely than benzodiazepines to be habit-forming, but over time can still sometimes cause physical dependence. They can work quickly to increase drowsiness and sleep. Another sleep aid, called Rozerem, acts differently from other sleep medicines. It affects a brain hormone called melatonin, and it’s not addictive. Belsomra and Quviviq are unique sleep aids that affects a brain chemical called orexin and is not addictive. Another sleep medicine that is not addictive, Silenor, is a low-dose form of the tricyclic antidepressant doxepin.

Like most medications, sleeping pills have side effects. You won’t know, though, whether you will have side effects with a particular sleeping pill until you try it.

Your doctor may be able to tell you about some side effects if you have asthma or other health conditions. Sleeping pills can interfere with normal breathing and can be dangerous in people who have certain chronic lung problems such as asthma , emphysema, or forms of chronic obstructive pulmonary disease (COPD).

Common side effects of prescription sleeping pills such as Ambien, Halcion, Lunesta, Rozerem, and Sonata include:

• Burning or tingling in the hands, arms, feet, or legs
• Changes in appetite
• Constipation
• Diarrhea
• Balance problems
• Dizziness
• Daytime drowsiness
• Dry mouth or throat
• Gas
• Headache
• Heartburn
• Impairment the next day
• Mental slowing or problems with attention or memory
• Stomach pain or tenderness
• Uncontrollable shaking of a part of the body
• Unusual dreams
• Weakness

It’s important to be aware of possible sleeping pill side effects so you can stop the drug and call your doctor immediately to avoid a more serious health problem.

If you’re 65 or older, experts suggest that you avoid all sleep aids. This includes over-the-counter drugs and the newer “Z” drugs like eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien).

Compared to younger people, older adults have a greater chance of health problems on sleep meds. When you’re older, sleeping pills tend to stay in your system longer. Drowsiness can last into the day after you’ve taken them. Confusion and memory problems are also a known side effect. For older adults, this could result in falls, broken hips, and car accidents.

Other symptoms of some over-the-counter sleep medications can be especially hard for older adults to handle. Your mouth may be dry. You may also be constipated and find it hard to pee.

Before you decide to take sleeping pills, talk to your doctor. They may recommend a medical exam to help you figure out the cause of your sleep problems, like depression, anxiety, or a sleep disorder.  Your doctor will also suggest ways to treat sleeplessness without drugs.

Some sleeping pills have potentially harmful side effects, including parasomnias. Parasomnias are movements, behaviors, and actions over which you have no control, like sleepwalking. During a parasomnia, you are asleep and unaware of what is happening.

Parasomnias with sleeping pills are complex sleep behaviors and may include sleep eating, making phone calls, or having sex while in a sleep state. Sleep driving, which is driving while not fully awake, is another serious sleeping pill side effect. Though rare, parasomnias are difficult to detect once the medication takes effect.

Product labels for sedative-hypnotic medicines include language about the potential risks of taking a sleeping pill. Because complex sleep behaviors are more likely to occur if you increase the dosage of a sleeping pill, take only what your doctor prescribes — no more.

Yes. People can have an allergic reaction to any medicine, which could be related to either the active ingredient of the medicine itself or to any of its inactive ingredients (such as dyes, binders or coatings). People who have an allergic reaction to a specific sleeping pill should avoid it. It’s important to talk to your doctor at the first sign of these serious side effects, including:

• Blurred vision or any other problems with your sight
• Chest pain
• Difficulty breathing or swallowing
• Feeling that the throat is closing
• Hives
• Hoarseness
• Itching
• Nausea
• Pounding heartbeat
• Rash
• Shortness of breath
• Swelling of the eyes, face, lips, tongue, or throat
• Vomiting

In addition, a serious — even deadly — side effect of any medicine someone is allergic to is anaphylaxis. Anaphylaxis is an acute allergic reaction. Another possible effect is angioedema, which is severe facial swelling. Again, discuss these possibilities with your doctor if you are at risk of allergic reactions.

It’s usually recommended that you take the sleeping pill right before your desired bedtime. Read your doctor’s instructions on the sleeping pill prescription label. The instructions have specific information regarding your medication. In addition, always allow ample time to sleep before you take a sleeping pill.

Yes. Mixing alcohol and sleeping pills can have additive sedating effects from both drugs, and the combination can cause someone to stop breathing, which could cause death. Sleeping pill labels warn against using alcohol while taking the drug.

Also, you should not eat grapefruit or drink grapefruit juice while taking some sleeping pills. Grapefruit increases the amount of the drug absorbed into your bloodstream and how long it stays in the body. That can cause over-sedation.

For short-term insomnia, your doctor may prescribe sleeping pills for several weeks. Yet after regular use for a longer period, some sleeping pills such as benzodiazepines or benzodiazepine agonists such as zolpidem or eszopiclone may stop working as you build a tolerance to the medication. (However, tolerance has not been shown with non-habit-forming sleeping pills like Belsomra, Rozerem, or Silenor. ) You may also become psychologically dependent on the medicine. Then the idea of going to sleep without it will make you anxious.

Without the sleeping pill, you might find it difficult to sleep. If that happens, it could be a sign of a physical or emotional dependence or both. Some studies show that long-term use of sleeping pills actually interferes with sleep. The best way to avoid developing a physical or emotional dependence on sleeping pills is to follow your doctor’s instructions and stop taking the drug when recommended.

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“No sleeping pill is more effective than placebo”

– What is sleep?

– The answer to this question is not as simple as it seems. Approaches to assessing the state of sleep, its course and functional purpose have not yet been fully developed. From the point of view of biology, for the same wild animal, it is very dangerous: it fell asleep where it was not necessary and was eaten. Therefore, beings usually hide. In addition, there is a certain threshold of sensitivity – the strength of smell and sound, for example. It would seem, what is the point of this dangerous deprivation, that is, the deprivation of external information: visual, auditory, tactile, and so on?

Our scientist, Ivan Nikolaevich Pigarev, developed and experimentally proved the theory that during sleep the brain processes information from internal organs. This is necessary for reparation processes.

— How far has human sleep evolved from animals?

– Oddly enough, not too much. For example, the sleep of a person and a medicinal cuttlefish, which is located at a “distance” of 350-500 million years from us, are almost the same, as well as that of a fruit fly. And even sleep phases have a certain periodicity. Of course, if we compare, for example, the respiration of such different species, they will be different, but the state itself is very similar, and even if we talk about primitive organisms without a nervous system.

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— Does this mean that we can transfer the results of animal model studies to humans, for example, in studies of drugs for insomnia?

– The toxicity of drugs is, of course, tested on animals, but the effect is on volunteers, since the nature of sleep disorders in people is very different. In addition, our brain is an extremely complex structure. An interesting fact:

in one of the large studies showed that in one way or another, almost no sleeping pills, including even the most modern ones, are more effective than placebo. One and the same substance can work well for someone, and not work at all for someone. And even in the side effects of some drugs it is written that insomnia is possible.

In addition, when treating a patient, we actively use non-drug approaches: various devices, light, and behavioral therapy.

— What are the approaches to the study of sleep?

– They are primarily associated with the brain, and it is difficult to study it even in the waking state. If we want to use MRI for routine brain research, during the procedure itself, the patient will hear a very loud knock, the squeal of magnets, and so on, that is, it will be impossible to sleep.

Basically, for such studies, we use polysomnography, which provides for the fixation of many physiological parameters, up to 60 and even more. To do this, you need to use an encephalogram, an electromyogram, and a cardiogram. We also do biochemical tests. For example, we determine the content of melatonin in saliva, evaluate motor activity, and measure temperature.

We don’t yet have enough methods to fully understand how the brain works during sleep, so a lot of the research is done on animals. Optogenetics is very informative when we introduce an optical fiber into the brain, send an optical signal through it and see how it affects the genetically modified receptors of the nervous tissue. Of course, such work is forbidden to be carried out on people.

— Are there many professional somnologists in Russia?

— I have been working in this area for more than 30 years and I can say that there are few scientific groups — biologists, doctors — but there are enough doctors who call themselves somnologists, mostly those who practice in commercial centers. Although in the 1990s, somnology flourished largely thanks to the groups of Alexander Moiseevich Wayne, who is considered to be the founder of Russian sleep medicine.

How common are sleep problems?

– As practice shows, 100% of people have them, just not everyone is permanent. If we are talking about respiratory disorders (apnea, that is, stopping breathing during sleep), the clinical manifestation of which is snoring, according to various estimates, their prevalence is about 50% in people over 50 years old.

Stops in breathing happen to any person, even healthy, but they acquire clinical significance if there are more than five of them per hour. If we are talking about chronic insomnia, then the figure ranges from 15 to 30% of the general population. This is a lot.

— How to understand that it is time to go to a specialist?

– When a person has a persistent sleep disorder. We usually talk about a chronic process if it lasts more than three months. It is good that people most often do not suffer for so long, but immediately go to the doctor, but this is in the case of insomnia. Many other diseases can go unnoticed, especially if the patient lives alone and there is no one to notice his snoring and respiratory arrest. But even in this case, it is worth analyzing your state after waking up. Sleep should give a surge of energy, normal appetite and good mood, and during the day you should not want to sleep.

Unfortunately, visits to a general practitioner or even a neurologist can end in nothing if these doctors have not been trained in sleepology. If you come to them and say that you are not sleeping well, they will most likely prescribe sleeping pills for you, however, such a “treatment” may be completely contraindicated, for example, when breathing stops. So if you have problems with sleep, then go straight to the somnologist. It is worth remembering that the level of their knowledge varies greatly and you need to carefully choose a specialist.

— What advice can you give for healthy sleep?

— First of all, we need to change our attitude to sleep! Unfortunately, most people think that sleep is some kind of disturbing state of life, because during sleep you can’t play a computer, watch TV, and so on. Remember: Trying to reduce your sleep will not improve your life, it will only make it worse. Both health and well-being deteriorate, and life expectancy is also reduced.

Secondly, there should be a fixed time for falling asleep and waking up, both on working days and on weekends. Be sure to pour out your norm, for most adults it is from seven to nine hours.

Thirdly, it is necessary to be in the sun during the day, because it is under its light that melatonin production is suppressed during the day and restored at night, which determines the quality of our sleep.

More general advice is to cut down on caffeine, tobacco, and alcohol, and to stay physically active. If even in this case there are problems with sleep, you should definitely go to a somnologist.

— What are the most dangerous sleep myths?

– Well, for example, about heroic snoring. It is believed that the louder the snoring, the stronger the man and, they say, health is unmeasured, hero! However, the louder the snoring, the more pauses in breathing and the worse the state of sleep in a person. Lack of oxygen can even be fatal. It is good that the media has recently debunked this myth, and many people begin to perceive snoring as a sign of pathology.

Another myth about sleeping at any time. It is especially popular among shift workers. Alas, this is not the case and causes major health problems.

— Which case from practice do you remember the most?

– There are a lot of them! One of the last – in 30 years of practice, I have had only five such patients: a woman has a sleep and wake cycle that is not 24 hours, like everyone else, and as a result, the time to fall asleep and wake up shifts all the time.

Our internal clock normally reacts to the change of day and night, but if we are placed in a dark cave, the cycle will shift. I had a patient with the same problem, his cycle went through a full turn in a month. The person slept a normal time, 7-8 hours, but every day fell asleep about 20 minutes later.

This is very interesting, we are now studying such patients, but most likely this is a genetic disorder.

— To what extent is sleep determined by genetics?

– In 2017, the Nobel Prize was awarded for the discovery and description of the genes that provide our biorhythms, in particular the state of sleep. They turn on and off when we are awake or sleeping, protein synthesis starts or stops, various metabolic chains are launched. So yes, genetics is very important.

— What about the popular division into owls and larks?

– This is partly in our genes, but only about 10% of pure owls and larks, in which the regime lasts a lifetime. Most are so-called pigeons that get up and go to bed not too late. In addition, with age, our biorhythms change: most children are larks, young people are shifting towards owls.

– What affects it? Hormones, tissue condition?

— Everything influences. For example, with age, less melatonin is produced, sensitivity to certain hormones is lost, and so on. As a result, sleep also changes.

— Have there been new methods of sleep research?

— Now we are moving towards creating a completely innovative method for studying the sleeping brain — a very ambitious and difficult task, but just as interesting for that.

How sleeping pills work and what insomnia is like

Science has 82 types of sleep disorders, including such exotic things as stopping breathing during sleep – “apnea”. The study of such disorders is carried out by a special science of sleep – somnology. After examining and taking anamnesis, somnologists can prescribe special sleeping pills, the principle of which we will tell you about.

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Perhaps everyone in this life has suffered from insomnia. On the eve of a holiday, before a difficult exam or interview, and sometimes just “because of the full moon.” Everyone struggles with the inability to fall asleep in different ways – someone drinks sleeping pills, someone drinks a glass of cognac at night, someone herbal tea, and some try to ensure a calm and quick falling asleep by following simple rules – ventilate the room before going to bed and drink a glass warm milk. All this is effective in its own way, but it does not help everyone. And although knowledge of the mechanisms of sleep in itself does not save from insomnia, nevertheless, this topic is close to everyone.

Do not self-medicate! In our articles, we collect the latest scientific data and the opinions of authoritative health experts. But remember: only a doctor can diagnose and prescribe treatment.

What is sleep

Sleep is a specific state of the nervous system, which manifests itself in the interruption of human ties with the outside world. As Leonardo da Vinci said about sleep, “sleep is a desired state that, once achieved, disappears for consciousness.” Little is known about sleep. The mechanisms of the brain that cause or regulate sleep and awakening are relatively well studied, but, for example, to the question “why sleep at all?” There is no definite answer yet, although there are many hypotheses. For example, some believe that unnecessary neural connections are destroyed during sleep, saving the brain from storing meaningless information. But so far it is only obvious that sleep is a biological human need: everyone has heard about the terrible torture of insomnia, and there is no doubt that sleep is necessary.

Falling asleep

In the nervous system, activity is regulated by two types of neurons – excitatory and inhibitory. They, respectively, release either excitatory or inhibitory neurotransmitters. The former excite the activity of the postsynaptic neuron, the latter suppress it. Sleep pills have their hypnotic effect on the body due to the influence of inhibitory mediators on the brain structure, which is responsible for “tuning” the nervous system to active work (it is called the reticular activating system).

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The main mediator that induces sleep is serotonin. Under its influence, neurons of a certain part of the brain are excited, which in turn activate neurons that release inhibitory neurotransmitters. Norepinephrine, on the contrary, is responsible for awakening. The subtleties of the interaction of brain structures with serotonin and norepinephrine have not been studied, but the fact that they take some part in the regulation of sleep and wakefulness is known for sure. Further, it is obvious that if inhibitory mediators are not enough to extinguish the activity of the desired part of the brain, falling asleep does not occur . As an illustration, everyone can remember that we usually cannot fall asleep when our nervous system is in an excited state – this is manifested in the fact that we cannot get rid of obsessive thoughts, constantly tossing and turning – we are either hot, or cold, or uncomfortable, we are annoyed by any rustle, etc.

Insomnia

According to various sources, from 25 to 50 percent of the world’s population suffers from insomnia, and 95 percent have experienced it at least once in their lives. Interestingly, insomnia indirectly affects even mortality – people with sleep disorders are 2.5 times more likely to get into car accidents. Insomnia is defined as a decrease in the amount and quality of sleep (and sometimes a change in the timing of sleep).

With quantity, everything is clear, but about quality (this is when you slept for twelve hours, but still “did not get enough sleep”) must be said separately. Research shows that normal sleep always has several phases – namely five. During each phase, the nature and amplitude of the waves of electrical activity of the brain on the encephalogram changes – according to these signs they are divided. In fact, the phase of sleep determines its depth: the first phase is the most superficial sleep, the fifth is the deepest. The fifth phase is also called REM sleep, or REM sleep, and the first four phases are therefore called non-REM sleep. To avoid confusion, I would like to emphasize that it is REM sleep that is the deepest and, although breathing and heartbeat are speeded up, the skeletal muscles of the sleeper are completely relaxed. Almost all people awakened during this phase say that they had dreams. So: it is known that the amount of REM and non-REM sleep must be balanced in a certain way. If any phases in a dream are missing, or they are very short, a person does not receive the necessary rest in a dream. For example, in one experiment, rats that were woken up whenever they entered REM sleep very soon went into nervous exhaustion and then death.

Although everyone’s need for sleep is different, everyone feels the amount and quality of sleep subjectively, evaluating whether he “gets enough sleep” or not. Some (Napoleon Bonaparte is said to be one of these) feel cheerful after four hours of sleep, and some (including the author) even after eight hours with difficulty force themselves to wake up. And, of course, there are “owls” and “larks”.

“For ease of reference” insomnia is classified according to the period in which difficulties with sleep appear – that is, they distinguish presomnic disorders (problems with falling asleep), intrasomnic (frequent awakenings) and postsomnic (early waking up, daytime sleepiness, decreased performance in the morning).

Sleeping pills

The mechanism of action of sleeping pills is very complex and, like sleep itself, has not been studied enough, but what is known is quite enough for a general acquaintance with their action. Today, a well-known inhibitory neurotransmitter is gamma-aminobutyric acid (GABA). For the first time, gamma-aminobutyric acid was discovered in the brain by E. Roberts and S. Frenkel in 1950. But its main property – the ability to reduce the activity of the nervous system – was discovered in 1963 by the English scientist K. Krnevich. Thus, to create a sleeping pill means either to increase the effect of GABA on neurons, or to increase its amount in the nervous system.

Barbiturates

The very first sleeping pills were experimentally discovered long before the existence of GABA was known. These were barbiturates (for example, veronal).

The mechanism of their action of these sleeping pills was already clarified during studies of the mechanisms of inhibition in the nervous system – it was found that the postsynaptic receptors of neurons responsible for inhibition are sensitive not only to GABA, but to varying degrees and to some other substances – in particular, to derivatives of barbiturates. Barbiturates, when attached to such receptors, lengthen the time of GABA exposure and also enhance this effect. However, due to the fact that receptors sensitive to barbiturates are responsible not only for sleeping pills, but also for anticonvulsant and relaxing effects, these sleeping pills there is a very pronounced side effect on the body (some drugs are even used in the treatment of epilepsy). In addition, with prolonged use of them as sleeping pills, the most important phase of REM sleep is shortened, that is, sleep is different from normal (in fact, sleep after such sleeping pills is only a physical state similar to sleep). Another trouble is the development of drug dependence with constant use for 1-3 months (and addiction develops in general in two weeks). Today, barbiturates are practically not used as sleeping pills.

GABA

After the discovery of GABA, an attempt was made to use the acid itself in its pure form as a sleeping pill (gamma-aminobutyric acid is a white powder soluble in water). However, it turned out that GABA practically does not get from the blood to the brain and, accordingly, the drug is ineffective, and has no effect on the human body.

Benzodiazepines

In further studies, it was found that some postsynaptic disorders are sensitive to benzodiazepine derivatives, and in the 60s of the XX century, the second generation of sleeping pills appeared. Benzodiazepines also indirectly (by attaching to “their” receptors) enhance the action of GABA. Since the receptors sensitive to these drugs are mainly responsible for the hypnotic effect, they have less side effects on the body than barbiturates. But some of the problems still remained: addiction, withdrawal syndrome, the need to constantly increase the dosage. In addition, although the REM phase is not shortened, the phase ratio does not correspond to physiological sleep, and heavy waking and daytime sleepiness limit the use of these hypnotics (in particular, you should not drive a car during the treatment period).

Latest generation

Further progress in the treatment of insomnia was marked by the discovery of several different types of receptors. It turned out that by selectively influencing some of them, it is possible to very accurately influence the braking mechanisms. This is how selective drugs appeared – the latest generation of sleeping pills. These are derivatives of imidazoperidine (ivadal) and cyclopyrrolone (imovan). The number of side effects they have is minimal, and the distribution of sleep phases is natural. True, the ideal has not yet been achieved – with prolonged use, there is still a danger of developing addiction. It is important to know that the effect of all sleeping pills is enhanced by alcohol (and vice versa, the effect of alcohol is potentiated by sleeping pills).

Histamine

Histamine is one of the most important mediators of wakefulness, so blocking histamine receptors (that is, receptors for neurons that are excited under the influence of histamine) also gives a hypnotic effect.

Drugs that block histamine receptors are called antihistamines. Their main task is to treat allergies, however, some pills can act as sleeping pills – this is considered a harmful additional property. Nevertheless, for some of these drugs (for example, diphenhydramine, pipolfen, donormil) it is so strong that they are considered full-fledged hypnotics. Fortunately, modern antihistamines are almost completely devoid of hypnotic action, since they do not pass through the blood-brain barrier brain) and do not affect the nervous system. Therefore, they can be taken constantly, without fear that during the flowering period of some next plant to which your body is hypersensitive, you will have to choose between sneezing and sleeping at work.

Melatonin

Melatonin is a neurohormone that is synthesized in our body from serotonin in the epiphysis, retina and intestines. The enzymes responsible for converting serotonin to melatonin are inhibited by light, so melatonin production is light dependent.

In humans, about 70% of the daily melatonin production occurs at night. Melatonin is somehow involved in the regulation of human circadian (daily) rhythms, that is, the rhythms of sleep and wakefulness. In particular, under the influence of melatonin, the amount of GABA in the nervous system increases.

Melatonin is considered a mild sleep aid and is recommended for minor sleep disturbances, including for faster adaptation when flying to other time zones. It also accelerates the adaptation of the body in a stressful situation and exhibits immunostimulating and antioxidant properties.

The ideal sleeping pill

In the light of the above, it becomes clear that very often the problem with insomnia is the usual overexcitation, so the recommendations “read at night” and “drink valerian” (which, by the way, also acts as a sleeping pill) can be effective . However, the scale of the production of sleeping pills indicates that it still has little effect on anyone.

The goal of any pharmacological research into sleeping pills is, of course, to find the perfect sleeping pill. In dreams, it is seen as follows: it acts quickly, does not lose effectiveness with prolonged use, is safe in case of overdose, does not have any effects other than sleeping pills, and also does not affect awakening, does not disturb sleep phases and does not change their normal ratio, does not cause disorders of the nervous system. system and problems upon termination of use.

So far, such a medicine has not yet been created, and it is unlikely that it will appear in the near future, although even now the first sleeping pills seem to be downright poison compared to modern ones.

Poisoning by sleeping pills

Sleeping pills are sold by prescription in our pharmacies. The reason is known – in large doses, barbiturates and benzodiazepines are life-threatening. Nearly half of suicide attempts are poisoning by sleeping pills, and about 10% of these attempts, unfortunately, are successful.