Is it bad to take sleeping pills: Common and Potentially Harmful Side Effects
Common and Potentially Harmful Side Effects
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.
What Are Sleeping Pills?
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 Halcion is an older benzodiazepine sedative-hypnotic medicine that has largely been replaced by newer medicines.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 is another unique sleep aid 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.
What Are the Side Effects of Sleeping Pills?
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
- Balance problems
- Daytime drowsiness
- Dry mouth or throat
- 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
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.
Sleeping Pills and Older Adults
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.
Are There More Complex Sleeping Pill Side Effects?
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.
Can I Be Allergic to Sleeping Pills?
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
- Pounding heartbeat
- Shortness of breath
- Swelling of the eyes, face, lips, tongue, or throat
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.
When Do I Take a Sleeping Pill?
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.
Is It Dangerous to Combine Sleeping Pills and Alcohol?
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.
Can I Become Dependent on Sleeping Pills?
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.
Are drugstore sleep aids safe?
Observe these caveats if you use over-the-counter drugs or dietary supplements to help you sleep.
Image: © Spauln/Getty Images
It’s 2 a.m. and you can’t sleep. Is it okay to take a nonprescription remedy? “They’re not meant for the long term, but it may be okay for an occasional night of problems with sleep,” says sleep expert Dr. Lawrence Epstein, an instructor in medicine at Harvard Medical School.
But which option should you reach for? Drugstore shelves are lined with a dizzying array of products promising a good night’s sleep. They fall into two categories: nonprescription medications and dietary supplements.
Sleep medications that are available over the counter use antihistamines as their main active ingredient. Nytol, Sominex, and Unisom (the blue capsule form), for example, contain 25 to 50 milligrams (mg) of the antihistamine diphenhydramine per pill.
Other over-the-counter sleep medications, such as Unisom SleepTabs, contain 25 mg per pill of an antihistamine called doxylamine succinate.
These medications work by blocking certain brain chemicals, which can have a sedating effect. They are generally safe but come with some risks. “You tend to become tolerant of the effect relatively quickly, so they stop working for you. And we don’t have a lot of long-term data about what happens if you use them for long periods of time,” Dr. Epstein says. “And there is the potential that antihistamines may cause side effects in older adults, such as confusion and falls.”
Another risk: some over-the-counter sleep aids contain other medications. For example, Tylenol PM contains not only 25 mg of diphenhydramine but also 500 mg of acetaminophen, a pain reliever. You might not be aware of that if you’re focused only on the sleep benefits of a medication.
Many kinds of supplements claim to help you sleep. For example:
Valerian root. The root of this tall, flowering plant is said to help people fall asleep and to quell anxiety and stress. It has been used as a medicinal herb since the days of ancient Rome.
Chamomile. Use of this flower, which looks like a daisy, also goes back thousands of years. It’s taken in pills as well as teas (many people drink a cup of chamomile tea at bedtime). It is considered mild and safe to help you become drowsy. But some people have an allergic reaction to chamomile (especially those who are allergic to ragweed).
Melatonin. This supplement comes from a lab, not a plant. It’s a synthetic version of the human hormone that helps regulate your sleep-wake cycle. But Dr. Epstein says it’s not a sleep medication. “It makes people a little sleepy, but it has a much greater effect in shifting the timing of the sleep phase,” he explains.
Dr. Epstein advises taking one to three mg of melatonin two to three hours before bedtime, if you’re trying to better align your sleep cycle because of jet lag or a night-shift job. He says you can take melatonin safely for the long term.
A word about prescription sleep aids
Prescription sleep medications are powerful drugs that work on different parts of the brain.
Benzodiazepines like lorazepam (Ativan) and temazepam (Restoril) target gamma-aminobutyric acid (GABA), a brain chemical that reduces nerve activity and promotes sleep. These medications can be habit forming, may cause daytime sleepiness, and may be associated with dementia.
Nonbenzodiazepines — such as zolpidem (Ambien) and eszopiclone (Lunesta) — also work on GABA, but they leave the body faster and have fewer side effects, allowing for regular waking and daytime functioning the next day. However, they still increase the risk for sleepwalking and daytime sleepiness, which can lead to falls and injury.
Melatonin-receptor agonists such as ramelteon (Rozerem) target melatonin receptors in the brain. They leave the body quickly and are not thought to be habit forming.
These medications are meant for short-term use only, under the direction of your doctor. “They’re most helpful for the treatment of insomnia. But medications are just one option to treat insomnia. Behavioral therapy, which involves looking at your sleep habits and ways you think about sleep and routines, is equally effective,” says sleep expert Dr. Lawrence Epstein, an instructor in medicine at Harvard Medical School.
A word of caution
Even though supplements are widely taken to help people sleep, we don’t actually know if they work.
“There are essentially no data on any of the herbal supplements that show effectiveness, except for a minor beneficial effect of valerian root,” Dr. Epstein says.
Many supplements can have minor side effects, such as headache, dizziness, or nausea. Or they may increase the effect of alcohol or other drugs you’re taking, such as other sleep medications.
Perhaps the biggest concern is that the FDA doesn’t regulate supplements, so there’s no way to know if a pill contains what its manufacturer claims.
What you should do
If you want to take an over-the-counter sleep drug or a dietary supplement, speak with your doctor or pharmacist to make sure it won’t interact with any medications you’re taking.
If you’re having more than an occasional night of sleeplessness, it may be time to figure out what’s causing the trouble.
“Most sleep problems can be corrected without medication,” Dr. Epstein says. “But it may take many approaches. Sleep problems are often caused by many things, not just one thing that can be fixed with a pill.”
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Long-Term Sleeping Pill Use: Risks & Effects | Blog
Published on September 27, 2019
Reading Time: < 1 minute
Dr. Carl Rosenberg
Americans experience a lot of sleepless nights. An unprecedented 50-70 million Americans have sleep problems according to estimates. Insomnia is the most common sleep disorder and the CDC says that more than one third of the country regularly gets less than the recommended amount of rest. With so many people struggling to get enough sleep, sleeping pills have become increasingly popular.
Prescription and over-the-counter sleep aids are meant to be used occasionally, but people are depending on them more and more for nightly relaxation. Medical experts are concerned with this trend because of the negative long-term health effects of these drugs.
Long-Term Use of Prescription Sleep Aids
Sleeping pills are drugs categorized as sedative-hypnotics. The most commonly prescribed medications are Ambien, Sonata and Lunesta. These are powerful drugs which are supposed to be used in small doses and only for short-term treatment of insomnia and other sleep disturbances. A patient’s need for prescription sleep aid should be re-evaluated after just 10-28 days. This is clearly stated in the drug information provided to patients by the pharmaceutical company.
Relying on sleeping pills for longer periods of time or in higher doses increases the likeliness that that person will experience negative side effects. Some of the health issues that have been associated with these medications include:
- Dizziness and lightheadedness,
- Nausea and vomiting,
- Sleep walking,
- Impaired motor skills and lack of coordination,
- Daytime drowsiness, and
Additionally, drugs like Ambien, Sonata and Lunesta have been connected to an increased risk for falls, injuries and car accidents. Some research has also shown a significantly higher diagnosis of cancer for patients regularly taking sleeping pills. According to the FDA, sleep aids can have dangerous effects by decreasing blood pressure, the heart and breathing rate if taken together with other prescription medications.
The Risk of Dependency & Addiction
The Journal of the American Medical Association has found that more than 68% of patients prescribed sleeping pills take them for longer periods than advised. They also found that many were taking larger quantities than the prescribed dosage. This trend is a problem because these controlled substances are habit forming. There is a high risk of becoming dependent on sleeping pills. There is also a danger of becoming psychologically dependent on taking a pill to help you relax and fall asleep.
Most people do not understand that they have formed an addiction to the medication until they try to stop taking it. Here are the warning signs of a dependence on these types of drugs:
- Experiencing withdrawal symptoms when not taken,
- Being unsuccessful at stopping,
- Anxiety when the medication is not available,
- Requesting refills from multiple doctors, and
- Frequent memory loss.
If you think you may be struggling with a drug dependency or are concerned about a loved one, please seek professional help. You can find more information from the National Institute on Drug Abuse.
Related article: Opioid Use May Increase the Risk of Sleep Disorders.
Long-Term Use of Over-the-Counter Medications
Medical professionals are also concerned about the number of Americans who rely on over-the-counter drugs to help them sleep. Medications, like Benadryl and Tylenol PM containing diphenhydramine, may seem harmless but can have a strong effect on the body. These drugs decrease brain function making it difficult to stay alert.
Non-prescription these types of medications can affect learning and memory in the long term and can be especially dangerous for seniors. For example, research by the Journal of the American Medical Association has found a strong link in regular use of these drugs and dementia.
Watch this video to learn more about the safety concerns related to over-the-counter sleep aids.
Learn more about the 10 Effects of Long-Term Sleep Deprivation and Proven Tips to Fall Asleep Faster.
Why Aren’t You Sleeping?
Sleeping pills are not a valid long-term treatment for insomnia or other sleep disorders. They can have serious side effects for your health, but they also do not solve the problem. Regular reliance on medications can actually keep someone from being properly diagnosed.
To successfully address the issue, it is first necessary to identify the underlying sleep disorder with the help of sleep testing. There are drug-free, long-lasting therapy options available for people struggling with ongoing sleep deprivation. For example, cognitive behavior therapy has been shown to be an effective treatment for stress-related problems and insomnia.
If you are having problems falling asleep or getting enough rest during the night, talk to your physician about a clinical sleep evaluation. Do not become a victim of long-term sleep deprivation. Contact Sleep Health Solutions to schedule a consultation today.
Prescription sleeping pills: What’s right for you?
Prescription sleeping pills: What’s right for you?
Sleeping pills may help when stress, travel or other disruptions keep you awake. For long-term insomnia, behavior changes learned in behavioral therapy is usually the best treatment.
By Mayo Clinic Staff
If you’re regularly having trouble either falling or staying asleep (insomnia), make an appointment with your doctor. Treatment depends on what’s causing your insomnia. Sometimes, an underlying cause, such as a medical condition or sleep disorder, can be found and treated — a much more effective approach than just treating the symptom of insomnia itself.
Behavior changes learned through cognitive behavioral therapy are generally the best treatment for persistent insomnia. Sleeping on a regular schedule, exercising regularly, avoiding caffeine and daytime naps, and keeping stress in check also are likely to help. But there are times when the addition of prescription sleeping pills may help you get some much needed rest.
All prescription sleeping pills have risks, especially for people with certain medical conditions, including liver or kidney disease. Always talk with your doctor before trying a new treatment for insomnia.
Here’s information on some of the most common types of prescription sleeping pills used today.
Types of prescription sleeping pills
Prescription sleeping pills may help you fall asleep easier or stay asleep longer — or both. The risks and benefits of various prescription sleeping pills can differ. To find the right prescription medication to help you sleep, your doctor generally should:
- Ask questions to get a clear picture of your sleep patterns
- Order tests to rule out any underlying conditions that may be causing difficulty sleeping
- Discuss options for taking prescription sleeping medication, including how often and when to take it and in what form, such as pills, oral spray or dissolving tablets
- Prescribe a sleeping pill for a limited period of time to determine the benefits and side effects for you
- Have you try a different prescription sleeping pill if the first medication you take doesn’t work after the full prescribed course
- Help you determine whether there is a generic version, which is typically less expensive than brand-name drugs
Insurance companies may have restrictions on which sleeping pills are covered, and they may require that you try other approaches to your insomnia first.
Prescription sleep medication options include the following.
|Sleep medication||Helps you fall asleep||Helps you stay asleep||Can lead to dependence|
|Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist)||✔||✔|
|Zolpidem extended release (Ambien CR)||✔||✔||✔|
Side effects of prescription sleeping pills
Always ask your doctor about potential side effects before deciding which sleeping pills to consider taking. Depending on the type, prescription sleeping pills may include side effects such as:
- Dizziness or lightheadedness, which may lead to falls
- Gastrointestinal problems, such as diarrhea and nausea
- Prolonged drowsiness, more so with drugs that help you stay asleep
- Severe allergic reaction
- Sleep-related behaviors, such as driving or eating when not fully awake
- Daytime memory and performance problems
Antidepressants with a sedating effect
Sometimes prescription drugs used mainly to treat depression may ease insomnia when taken in lower doses. Although widely used, these are not approved by the Food and Drug Administration for insomnia. When insomnia is secondary to depression or anxiety, antidepressants may improve both conditions at the same time.
- Mirtazapine (Remeron)
Side effects of antidepressants with a sedating effect
Antidepressants that have a sedating effect may include side effects such as:
- Dizziness and lightheadedness
- Prolonged drowsiness
- Dry mouth
- Irregular heartbeat
- Weight gain
- Daytime memory and performance problems
Prescription sleeping pills (and even some nonprescription sleeping pills) as well as certain antidepressants may not be safe if you are pregnant, breast-feeding or an older adult. Sleeping pill use may increase the risk of nighttime falls and injury in older adults. If you’re an older adult, your doctor may prescribe a lower dose of medication to reduce your risk of problems.
Some health conditions — for example, kidney disease, low blood pressure, heart rhythm problems (arrhythmias) or a history of seizures — may limit your options. Also, prescription drugs and over-the-counter sleep aids may interact with other medications. And taking certain prescription sleeping pills can lead to drug abuse or drug dependence, so it’s important to follow your doctor’s advice.
Taking sleeping pills
If your best attempts to get a good night’s sleep have failed, prescription sleeping pills may be an option. Here’s some advice on how to use them safely.
- Get a medical evaluation. Before you take sleeping pills, see your doctor for a thorough exam. Often your doctor may be able to find specific causes for your insomnia. If you’re taking sleeping pills for more than a few weeks, talk to your doctor about an appropriate follow-up schedule to discuss your medications.
- Read the medication guide. Read the medication guide for patients so that you understand how and when to take your medication and what the major potential side effects are. If you have any questions, ask your pharmacist or your doctor.
- Never take a sleeping pill until you’re going to bed. Sleeping pills can make you less aware of what you’re doing, increasing the risk of dangerous situations. Wait to take your sleeping pill until you’ve completed all of your evening activities, immediately before you plan on sleeping.
- Take your sleeping pill when you can get a full night’s sleep. Only take a sleeping pill when you know you can get a full night’s sleep of at least seven to eight hours. A few short-acting sleeping pills are intended for middle of the night awakenings, so you may take them when you can stay in bed for at least four hours.
- Watch for side effects. If you feel sleepy or dizzy during the day or if you experience any other significant side effects, talk to your doctor about changing your dose or weaning off your pills. Don’t take a new sleeping pill the night before an important appointment or activity because you won’t know how it affects you.
- Avoid alcohol. Never mix alcohol and sleeping pills. Alcohol increases the sedative effects of the pills. Even a small amount of alcohol combined with sleeping pills can make you feel dizzy, confused or faint. Combining alcohol with certain sleeping pills can lead to dangerously slowed breathing or unresponsiveness. And alcohol can actually cause insomnia.
- Take sleeping pills strictly as prescribed by your doctor. Some prescription sleeping pills are for short-term use only. Be sure to contact your doctor for advice. Also, don’t take a higher dose than prescribed. If the initial dose doesn’t produce the intended effect on sleep, don’t take more pills without first talking to your doctor.
- Quit carefully. When you’re ready to stop taking sleeping pills, follow your doctor’s or pharmacist’s instructions or the directions on the label. Some medications must be stopped gradually. Also, be aware that you may have some short-term rebound insomnia for a few days after you stop taking sleeping pills.
If you continue to have trouble sleeping, ask your doctor for additional help.
Jan. 30, 2018
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Here’s Why You Shouldn’t Take a Sleeping Pill Every Night
Tens of millions of Americans struggle to sleep at night, and many of them turn to sleeping pills for relief. Prescription and over-the-counter sleep aids are especially popular among older adults. A recent study published in the American Journal of Geriatric Psychiatry found that roughly one in three adults ages 65 to 80 use these drugs at least occasionally to fall asleep, and OTC meds like Benadryl and Tylenol PM are the pills of choice for sleepless seniors.
Experts say this is concerning for a number of reasons. Studies have linked the regular, long-term use of OTC sleep medicines to some potentially serious side effects.
“Many OTC sleep aids—such as Benadryl and Tylenol PM—contain diphenhydramine,” says Dr. Donovan Maust, co-author of the recent study and an assistant professor of psychiatry at Michigan Medicine. Diphenhydramine is an anticholinergic drug, which means it blocks activity of a brain chemical called acetylcholine, which plays a role in muscle activation and also in brain functions like alertness, learning and memory, Maust says.
As a result of this blocking effect, these OTC drugs can cause constipation, confusion and other side effects, which Maust says may be more likely to affect older adults. For these reasons, the American Geriatric Society has deemed these drugs “generally inappropriate” for seniors.
The side effects of these OTC pills can also set off a “prescribing cascade,” says Jennifer Schroeck, a clinical pharmacist with the U.S. Department of Veterans Affairs Western New York Healthcare System and co-author of a 2016 review published in the journal Clinical Therapeutics on the safety of sleep aids among older adults.
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For example, in men with prostate conditions, anticholinergic drugs can lead to urinary retention, or problems fully emptying the bladder, Schroeck says. A man experiencing this issue may not attribute it to the sleep medicine he’s taking at night to sleep, and if he fails to mention it to his doctor, he may be prescribed a new medication to treat his bladder problems. “That new drug may have side effects too, so then something else is added to manage those,” she says. In this way, the medications a patient is taking—and their many side effects—can add up quickly.
There is also growing worry about another more-serious risk associated with these OTC drugs. “Another concern for which evidence is growing is that long-term use appears to increase the risk of dementia—and the more use, the greater the risk,” Maust says.
One 2015 study published in JAMA Internal Medicine found that over a 10-year period, people who regularly took the amount of diphenhydramine found in two Benadryl or two Extra Strength Tylenol PM pills roughly once every week or two were at significantly increased risk for dementia. For individuals who took these drugs about once every three days (or more), their dementia risks rose by 54% compared to people who did not take these types of medications.
The links between these OTC drugs and dementia are far from certain. A more recent study from the UK turned up only “tentative” links, and its authors stated that more research is needed. “But the only way to 100% attribute a health issue to any specific treatment is through a randomized trial,” Maust says, referring to an experiment in which one group of people is given a drug and another is not. (To his knowledge, these studies are not being done.)
Prescription sleep aids carry their own risks. “There are new reports of side effects coming out on a yearly basis,” says Kari Mergenhagen, a clinical pharmacist and adjunct instructor at the University of Buffalo. (Mergenhagen was also a co-author on the Veterans Affairs sleep-aid study.) Headaches, dizziness, nausea, vomiting and hallucinations are a few of the short-term concerns associated with hypnotics—a class of prescription drugs designed to induce sleep that includes Ambien, Lunesta, Sonata and other popular meds, she says.
Mergenhagen says it’s very difficult for researchers to nail down the long-term risks associated with regular use of these drugs. One observational study published in 2012 in the BMJ looked at electronic medical records data from more than 30,000 adults and the usage of common hypnotics, including zolpidem (sold under the brand name Ambien and others), temazepam (Restoril), eszopiclone (Lunesta), zaleplon (Sonata) and other barbiturates, benzodiazepines and sedative antihistamines. The researchers found that those who were prescribed more than 132 doses of these hypnotic drugs per year—meaning those patients taking them at least every two or three days—had a 35% increase in cancer risk and a five-fold jump in risk of death compared to those not prescribed these drugs. Even people who took these drugs sparingly—like once every few weeks—were more likely to die than those who did not take them at all.
The authors of the study tried to control for pre-existing medical conditions and other factors that could explain why people taking these drugs died or developed cancer at higher rates than non-users. The drugs were also associated with car accidents, falls and depression—all of which could explain the elevated mortality risks. But the risks remained. The authors also found associations between the use of hypnotics and specific types of cancer—notably, lymphomas and cancers of the lungs, colon and prostate—but they did not offer any cause-and-effect mechanisms that might explain the links. More recent research, in both people and animals, has turned up more preliminary links to cancer.
The drugs are only meant to be used sparingly. The prescribing information for Ambien notes that the drug’s use should be “re-evaluated” if a patient’s insomnia persists after seven to 10 days of treatment—guidelines echoed by the makers of Lunesta. Both drugmakers define “long-term” use as anything beyond 28 days.
Even setting aside the potential risks and side effects, sleeping pills aren’t an effective long-term solution for insomnia. “The real question is, why aren’t you sleeping?” Schroeck says. Many older adults may take sleeping pills because pain, nerve problems or other health issues are keeping them up at night, she says. For these people, a sleeping pill is standing in the way of them finding a true remedy for the ailment.
Even for younger adults who can’t sleep because of stress, financial concerns or other sources of anxiety that are more difficult to treat, sleeping pills are a poor solution, she says. “Cognitive behavioral therapy should always be the first line of treatment,” she says. Other experts agree that cognitive behavioral therapy for insomnia—which can include strategies like establishing a consistent sleep routine, purposely restricting time spent in bed or practicing mindfulness-based meditation—is the best way to cure insomnia.
There’s still a time and place for prescription and OTC sleep aids. If you’re very stressed and need help nodding off the night before an important work or social event, these pills can be a big help. But if you’re taking them all the time—and especially if you’re older than 65—the risks these pills pose likely outweigh their benefits.
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Sleeping Pills For Insomnia | Choosing Wisely
They may not be the best treatment option
Insomnia (trouble sleeping) is a common problem. It’s considered “chronic” if it occurs three nights or more a week for at least three months.
If you have trouble sleeping, you may be thinking about getting a prescription for sleeping pills. But these drugs are often not the best option. And they can cause other problems. Here’s what you need to know.
Sleeping pills may be over-used.
Sleeping pills are one of the most-prescribed drugs in the US. This is partly because many patients ask for them. Also, many doctors prescribe sleeping pills instead of trying other treatments first.
Sleeping pills may not help as much as you think.
Sleep studies show that they only help people fall asleep about 8 to 20 minutes faster. And they add less than 35 minutes to nightly sleep.
Sleeping pills have risks and side effects.
If you take sleeping pills for many days in a row, one risk is that you may start to depend on them. You may need them to fall asleep. If you stop taking them, you may sleep worse than you did before you tried the pills. This is why most doctors recommend you only take them occasionally, or for a few days in a row.
Other risks and side effects may include:
- Daytime drowsiness
- Dizziness and hallucinations
- Sleepwalking and sleep-eating
Over-the-counter sleep aids, such as antihistamines (Benadryl, Tylenol PM, and generic), have risks, too. Ask your doctor if these are safe for you.
Counseling can help you avoid sleeping pills.
A type of short-term counseling called cognitive-behavioral therapy (CBT) may be a better option for you. It usually works at least as well as sleeping pills, and it doesn’t have any of the risks.
Most people sleep better with CBT. With CBT, you may learn new sleeping habits, for example:
- To get up at the same time every day.
- To stop watching TV in bed.
- How to calm your mind when you’re trying to sleep.
CBT may cost less.
Sleeping pills can cost from $17 to $60 a week. Some newer drugs may cost even more. Your doctor visits are added costs.
Over time, CBT may cost less. For CBT, you may need only six one-hour sessions. Usually, you meet with a psychologist trained in CBT for insomnia.
Are sleeping pills ever a good idea?
Sleeping pills may be helpful if you have short-term insomnia caused by a stressful event—such as a death in the family, a major illness, or a divorce.
If you’re starting CBT, it may help to take sleeping pills for a short period of time. This may help you adjust as you develop new, improved sleep habits.
How can I stop taking sleeping pills?
If you’ve been taking sleeping pills for a long time, ask your doctor how to stop. It may take days, weeks, or months to stop safely.
When should I see a sleep specialist?
Your doctor may refer you to a sleep physician for a sleep study. In a sleep study, your body is observed as you sleep. Usually, you only need a sleep study if you might have another sleep problem, such as sleep apnea, that is causing your insomnia. Common warning signs of sleep apnea include:
- Snoring loudly or frequently.
- A bed partner says you stop breathing during your sleep.
- You are very sleepy during the day.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
© 2018 Consumer Reports. Developed in cooperation with the American Association of Sleep Medicine.
Sleeping Pill Addiction, Abuse And Treatment Options
More than one-third of American adults regularly do not get enough sleep, according to a study from the Centers for Disease Control and Prevention (CDC).
Although there are several healthy ways to improve sleeping habits, many people find it easier to take a pill before bed. Before they know it, they develop a sleeping pill addiction on top of these other stressors.
Although it might seem relatively harmless compared to other types of addictions at first glance, sleeping pill addiction can cause significant long-term brain damage and may even be fatal.
Signs Of Sleeping Pill Addiction
Nearly nine million Americans take prescription sleeping pills to go to sleep, mostly consisting of popular brands like Ambien (zolpidem) and Lunesta (eszopiclone). These are non-benzodiazepines, also called “z-drugs.”
Most people quickly develop a tolerance that requires them to take higher doses of these drugs for them to remain effective. This can lead to physical dependence—a physical craving for sleep medication—as well as addiction caused by changes in the brain with prolonged use.
Find Treatment For Sleeping Pill Addiction Today.
We are here to help you through every aspect of recovery. Let us call you to learn more about our treatment options.
Some people obtain sleeping pills illicitly and increase their dosage without a doctor’s recommendation Those who struggle with sleeping pill addiction are not alone in their struggle, and it’s crucial to be able to recognize when this behavior becomes problematic.
The following signs are indicators that sleeping pill use might have developed into an addiction:
- slurred speech
- impaired memory
- inability to focus
- lack of coordination or dizziness
- inability to sleep without sleeping pills
- several failed attempts at quitting
- cravings for sleep medication
- seeing more than one doctor for prescriptions
- relationship problems or financial trouble related to drug use
Essentially, if any of the consequences of taking sleeping pills have a significant negative impact on the person’s life, this is a sign that the dependence on sleeping pills may be out of control.
How Are Sleeping Pills Abused?
Sleeping pills are generally taken in pill form, though some people may crush them up and snort them for a faster effect.
A new trend among teenage and college-aged young adults is to combine sleeping pills with alcohol to maximize the sedative properties. This can be especially dangerous since excessive intake of these two drugs together can slow the central nervous system and cause breathing disturbances that could be fatal.
Although over-the-counter sleeping pills might seem less harmful since they are unregulated, people who take these drugs can just as easily develop an addiction to them.
Those taking over-the-counter sleeping medications like diphenhydramine (Nytol, Benadryl) and doxylamine (Unisom) often exhibit the same symptoms of addiction as those who are taking prescription sleep medication.
Some people who abuse sleeping pills may develop parasomnia, a sleep disorder that includes behaviors like sleepwalking, sleep-eating, sleep-driving, sleep-sex and other activities done while sleeping that can lead to deadly consequences.
Dangers Of Sleeping Pill Addiction
Dan Kaufer, MD, neurologist, and director of the UNC Memory Disorders program, notes that there are three classes of medications that can have severe cognitive side effects. These include benzodiazepines, opioids, and antihistamines.
Benzodiazepines like Restoril (temazepam) are often prescribed as sleep aids. These drugs can significantly impair memory and are not generally effective for long-term use as the body quickly builds a tolerance to them.
Over-the-counter antihistamines like Benadryl (diphenhydramine) may also be used for insomnia. These seemingly harmless drugs can cause confusion in older adults because they block acetylcholine, a brain chemical that affects short-term memory and attention.
Prolonged use of diphenhydramine can increase a person’s risk of dementia.
Sleeping Pill Overdose
A sleeping pill overdose can be deadly and is actually a common method of suicide. It can occur when a person takes a very high dose, especially if they use the drug frequently and it builds up in their system.
An overdose is also more likely when someone mixes sleeping pills with other depressants like opioids, benzodiazepines, and alcohol.
The following signs might indicate that a person with a sleeping pill addiction may have overdosed and needs immediate medical attention:
- extreme drowsiness
- difficulty speaking and recalling information
- depressed or abnormal breathing
An overdose on sleeping pills essentially shuts down the entire body, including the respiratory, nervous, and cardiovascular systems. If an overdose is not treated quickly, the person who overdosed may fall into a coma.
Slowed or stopped breathing can cause hypoxia—a lack of oxygen to the brain and body that can cause permanent brain and muscle damage. This may be indicated by bluish lips and fingernails.
Long term side effects of a sleeping pill overdose include the following:
- paranoid delusions
- memory loss
- face paralysis
- limited or no control over bodily functions
- development of psychological disorders
Sleeping Pill Withdrawal
According to Dr. Robert Epstein, an instructor in medicine at Harvard Medical School, many people who opt to stop taking sleeping pills will have a withdrawal response that prevents getting good sleep without them. This occurs when the body becomes physically dependent.
“If you stop too quickly you can get rebound insomnia, which makes symptoms worse,” explains Dr. Epstein. Stopping sleeping pill use abruptly can cause seizures in some people, so it is recommended that a person tapers off of these drugs under the supervision of a physician.
Those who are attempting to reduce their sleep medication use gradually should prepare for their sleep to be disrupted each time the dose is lowered because of the withdrawal effect.
The longer the individual has been taking medications, the slower the weaning process will be, which means it could last weeks and even months.
However, tapering usually reduces the severity of withdrawal symptoms and is the only way some people are able to overcome their physical dependence on sleeping pills.
Treatment For Sleeping Pill Addiction
At Vertava Health Ohio, we understand that anyone can unintentionally develop an addiction to a substance, despite efforts to use it responsibly. Our inpatient rehab program will not only help individuals overcome the addiction itself, but also the underlying causes of substance abuse.
By encouraging significant lifestyle changes, such as participation in cognitive behavioral therapy (CBT) and a regular exercise routine, we help people find healthy coping strategies and solutions to problems they would attempt to solve with substances.
With long-term care and continued support, anyone can find the strength they need to overcome sleeping pill abuse and enjoy a meaningful, substance-free life.
90,000 Benefits and harms of sleeping pills
Publication date: 26-09-2019
Updated date: 03-11-2020
Many people are familiar with the problem of insomnia, because in modern life, in the cycle of daily affairs, it is not always possible to rest, to correctly plan your mode of work, sleep, nutrition and rest; constant stress, increased emotional and physical stress can cause insomnia, and those who have encountered this problem at least once know how hard it is to get rid of it.
Over time, insomnia becomes chronic, and may indicate serious illnesses that already need to be treated by a good neurologist at the “NATALI-MED” medical center. Many people solve this problem, unfortunately, not by contacting a specialist at a good medical center in Strogino, but by taking regular pills. The sale of sleeping pills in the world reaches colossal proportions, and only a few come to see a neurologist.
You need to think about the fact that sleeping pills, in fact, can be harmful to health, and do not help fight insomnia.Sleeping pills have become a kind of placebo that can be easily dispensed with. This drug is best, of course, to be taken only on the recommendation of a neurologist at the medical center “NATALI-MED” and not to abuse these drugs.
Below we will look at the most common sleeping pills.
Phenazepam is well known to everyone, but it has a huge number of shortcomings; despite this, Russian doctors continue to prescribe it to their patients.This drug is mainly prescribed for patients of age who have suffered a stroke and can no longer fall asleep on their own. But after all, behind insomnia lies a huge number of problems that led to sleep disturbance: these are hectic daily activities, and lack of physical activity, and problems with the nervous system, and constant stress and many other factors that need to be addressed with the help of antidepressants, sleeping pills or a good neurologist in Strogino, a psychotherapist and other specialized specialists.
The fact is that Phenazepam is dangerous because it disrupts the structure of sleep, and even after sleeping for 8 hours, there is a feeling of fatigue, a headache, and a person feels completely overwhelmed: in addition, cognitive functions deteriorate, memory is impaired, the skill of analyzing and reproducing the received information, there is apathy, depressive state, convulsions and many other unpleasant symptoms.
Generation Z includes the following drugs: zopiclone, zaleplon and zolpidem, which allow you to get enough sleep without disturbing your sleep pattern.But they have one drawback – this is addiction: with prolonged use, drugs can disrupt the thinking ability and memorization of information. Any sleeping pills reduce concentration during the day, and the most common side effect is sleepiness during the day.
Once again, it is worth noting that the appointment of such strong sleeping pills as Phenazepam and drugs of group Z to those patients who have apnea syndrome can be extremely dangerous, therefore, before contacting a specialist, it is better to make sure of his experience, qualifications and confidence in that the doctor will correctly understand your problem and, based on the history and examination, will prescribe exactly those drugs that will be most effective and safe for you.
- Melatonin and Doxylamine.
Melatonin is a “sleep hormone” produced by the pineal gland. This drug is effective when a person’s biorhythms are disturbed. Recently, research has shown the beneficial effects of melatonin in depression, metabolic syndrome, and even obesity and cancer. It is important to understand that in addition to a large number of advantages, melatonin is not very effective for chronic insomnia, anxiety disorders, since it does not have a pronounced effect, like the above drugs.
Alternative to sleeping pills.
It is important to always understand the reasons that caused sleep disturbance and solve them: not always a person himself can understand what is the reason for lack of sleep. The best recommendations that can be given are: regular physical activity, spend more time outdoors, eat only fresh plant foods, try to avoid stress, come up with some intellectual tasks, walk more, use aroma baths, massage, deep breathing, practice meditation, perhaps change jobs if she is the main provocateur of your stress.
And, importantly, insomnia can be caused by comorbid conditions, such as heart failure or thyroid problems, which only need to be treated by a doctor.
Scientists have figured out how to deal with chronic insomnia without pills
Scientists have figured out how to deal with chronic insomnia without pills
Scientists have figured out how to deal with chronic insomnia without pills – RIA Novosti, 03.03.2020
Scientists have figured out how to deal with chronic insomnia without pills
The first sleeping pill – Veronal – appeared in 1864, when German chemist Adolf Bayer discovered barbituric acid and barbiturates. Since 1903, Veronal has already … RIA Novosti, 03.03.2020
Sechenov First Moscow State Medical University
Russian Academy of Sciences
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MOSCOW, May 25 – RIA Novosti, Alfiya Yenikeeva. The first sleeping pill, Veronal, appeared in 1864, when the German chemist Adolf Bayer discovered barbituric acid and barbiturates. Since 1903, Veronal has already been prescribed en masse to patients for insomnia. But the medicine had several serious shortcomings at once, and it had to be abandoned. A century and a half later, sleep disorders are still being treated with pills.Scientists promise to turn the tide in the near future. Three systems – one insomnia “The likelihood of falling asleep depends on the interaction of three systems in the brain. of these systems, shifting the balance between them towards sleep.Today, the most popular approach to sleep induction is the effect on the inhibitory systems of the brain, increasing their activity.First of all, we are talking about drugs – derivatives of benzodiazepines, the most famous of which is phenazepam, “explains Associate Professor of the Department of Nervous Diseases and Neurosurgery at the I.M.Sechenov First Moscow State Medical University, Head of the Sleep Medicine Department of the University Clinical Hospital No. 3, Candidate of Medical Sciences Mikhail Poluektov. the drugs act on special receptors in the brain – benzodiazepine, as a result of which the transmission of nervous excitement in the brain is inhibited and the person falls asleep rather quickly.At the same time, the duration of sleep increases, and there are fewer sudden awakenings in the middle of the night, but these drugs have two important drawbacks. First, they alter the normal pattern of sleep, suppressing its deep and rapid stages. In other words, a person who has taken the same phenazepam sleeps longer, but does not see dreams, and night rest does not bring him satisfaction. Secondly, these drugs can cause addiction, similar to narcotic. “Classical hypnotics such as phenozepam have the same mechanism of action as alcohol.With occasional intake, nothing bad will happen, but if you drink them regularly, as in the case of alcoholic beverages, of course, nothing good will come of it. Therefore, any hypnotic drug is still dispensed with a prescription, it is impossible to get it just like that “, – says the somnologist. Weaken and suppress The second most popular sleeping pills are blockers of histamine receptors. its work, then the braking systems will gain an advantage and the person will fall asleep.”Antiallergic drugs of the first generations, such as Suprastin, had a similar effect. They were very sleepy, because they acted not only on receptors associated with allergies, but also on receptors in the brain, which are related to the activating system. These drugs blocked it, and , accordingly, the balance shifted towards the braking systems, which contributed to falling asleep, “says Mikhail Poluektov. According to the doctor, the effect of this type of sleeping pills is weaker than the classic drugs, and they do not distort the normal structure of sleep – this is their advantage.In addition, these are the only sleeping pills allowed during pregnancy. Brain trickery “The struggle between activating and inhibitory systems is influenced by the time of day. At night, we fall asleep easier than during the day, thanks to our internal clock. They help the brain stay awake when light stimulates a specific area. Due to this, the brain knows that now the body needs to be as active as possible, and gives an additional impulse to the activating structures. As soon as it gets dark, this stimulation stops, the activating structures lose their advantage over the inhibitory ones, and the brain gradually goes to sleep.Therefore, it is possible to induce sleep also by deceiving the internal clock. If they are informed that it is already night, that the hormone melatonin has already begun to be produced, then the internal clock will cease to stimulate the activating systems and, accordingly, they will lose their advantage. For this, melatonin preparations are used – synthetic analogs of a hormone that is produced in humans and animals at night, “the specialist explains. The use of these drugs improves the time to fall asleep, slightly increases the duration of sleep and practically does not cause side effects.But their effect is much weaker than the hypnotics of the first two types. There is also evidence that taking synthetic melatonin after 45 years of age increases life expectancy. Although, according to Mikhail Poluektov, they should be treated with caution. “The experiments were carried out on rats. On other species of animals, as well as on humans, this has not been proven,” the scientist emphasizes. Better without pills Scientists continue to look for new ways to combat insomnia, including non-drug. For example, several research teams are working on the creation of special gadgets for fast falling asleep and sound long sleep.The authors of one of the devices are employees of the Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences. This is a small black cube with a side of ten centimeters, inside there are three coils, which are supplied with a pulse current of a certain frequency. A weak electromagnetic field arises, which, acting on the brain, naturally regulates circadian rhythms. The device has already shown its effectiveness in a small group of healthy volunteers. Whether he will be able to cure those suffering from chronic insomnia is not yet clear.Scientists from Sechenov University, together with colleagues from Switzerland, are developing the first program of cognitive-behavioral therapy for insomnia in Russian. “Most often, a person gets insomnia because he begins to worry about his sleep, behave incorrectly. He fixates on his problems and cannot Now there are certain methods of cognitive-behavioral therapy, but it takes a lot of time, competent specialists are needed, and in Russia, and in the whole world, there are very few such people.Now we are just working on a method of distance cognitive-behavioral therapy, so that a person, without a visit to a psychotherapist, from any part of our country, online, can go through these sessions. According to a thesis written at our university, the effectiveness of a two-week course is 28 percent. According to the estimates of foreign authors who wrote about the six-week treatment, the effectiveness of cognitive-behavioral therapy reaches 60 percent. This is comparable to the effectiveness of treatment with traditional sleeping pills.But the advantage of the psychological method is that its effect is not lost after stopping treatment. But after refusal from sleeping pills, sleep disorders always return, since the main reason for these disorders is not eliminated, “Poluektov concludes.
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Switzerland, Moscow, Sechenov First Moscow State Medical University, Russian Academy of Sciences, Mikhail Poluektov, Russia
MOSCOW, May 25 – RIA Novosti, Alfiya Enikeeva. The first sleeping pill, Veronal, appeared in 1864, when the German chemist Adolf Bayer discovered barbituric acid and barbiturates.Since 1903, Veronal has already been prescribed en masse to patients for insomnia. But the medicine had several serious shortcomings at once, and it had to be abandoned. A century and a half later, sleep disorders are still being treated with pills. Scientists promise to turn the tide in the near future.
Three systems – one insomnia
“The probability of falling asleep depends on the interaction of three systems in the brain. One activating system, the other inhibiting, the third – the internal clock system.And drugs that have a hypnotic effect affect the work of one of these systems, shifting the balance between them towards sleep. Today, the most popular approach to sleep induction is the effect on the inhibitory systems of the brain, increasing their activity. First of all, we are talking about drugs – derivatives of benzodiazepines, the most famous of which is phenazepam, “explains Mikhail Poluektov, Associate Professor of the Department of Nervous Diseases and Neurosurgery at the I. M. Sechenov First Moscow State Medical University, Head of the Sleep Medicine Department of the University Clinical Hospital No. 3, Candidate of Medical Sciences Mikhail Poluektov.
These drugs act on special receptors in the brain – benzodiazepine, as a result of which the transmission of nervous excitement in the brain is inhibited and a person falls asleep rather quickly. At the same time, the duration of sleep increases, and there are fewer sudden awakenings in the middle of the night.
But these drugs have two important drawbacks. First, they alter the normal pattern of sleep, suppressing its deep and rapid stages. In other words, a person who has taken the same phenazepam sleeps longer, but does not see dreams, and night rest does not bring him satisfaction.Secondly, these drugs can cause addiction similar to narcotic.
“Classic sleeping pills such as phenozepam have the same mechanism of action as alcohol. When taken occasionally, nothing bad will happen, but if you drink them regularly, as in the case of alcoholic beverages, of course, nothing good will come of it. Therefore, any sleeping pill all the same it is dispensed by prescription, it is impossible to get it just like that “, – says the somnologist.
March 9, 2018, 18:17They weaken the histaminergic system, which allows the brain to stay awake, and if suppressed, the inhibitory systems take advantage of and the person falls asleep.
“Antiallergic drugs of the first generations, such as Suprastin, had a similar effect. They were very sleepy, because they acted not only on receptors associated with allergies, but also on receptors in the brain, which are related to the activating system. These drugs blocked it. , and, accordingly, the balance shifted towards the braking systems, which contributed to falling asleep, “says Mikhail Poluektov.
According to the doctor, the effect of this type of sleeping pills is weaker than that of classical drugs, and they do not distort the normal structure of sleep – this is their advantage. They are also the only sleeping pills allowed during pregnancy.
April 6, 2016, 12:16 pm Scientists have found out how insomnia affects the brain Chronic insomnia disrupts the work of the white matter of the brain, which can lead to serious consequences for the body, say Chinese neuroscientists.
Deceiving the Brain
“The time of day influences the struggle between activating and inhibiting systems.It is easier for us to fall asleep at night than during the day, thanks to our internal clock. They help the brain stay awake when light stimulates a specific area of the hypothalamus. Due to this, the brain knows that now the body needs to be as active as possible, and gives an additional impulse to the activating structures. As soon as it gets dark, this stimulation stops, the activating structures lose their advantage over the inhibitory ones, and the brain gradually goes to sleep. Therefore, it is possible to induce sleep also by deceiving the internal clock.If they are informed that it is already night, that the hormone melatonin has already begun to be produced, then the internal clock will cease to stimulate the activating systems and, accordingly, they will lose their advantage. For this, melatonin preparations are used – synthetic analogs of a hormone that is produced in humans and animals at night, “the specialist explains.
The use of these drugs improves the time to fall asleep, slightly increases the duration of sleep and practically does not cause side effects.But their effect is much weaker than the hypnotics of the first two types. There is also evidence that taking synthetic melatonin after 45 years of age increases life expectancy. Although, according to Mikhail Poluektov, they should be treated with caution.
“The experiments were carried out on rats. On other species of animals, as well as on humans, this has not been proven,” the scientist emphasizes.
Better without pills
Scientists continue to look for new means of fighting insomnia, including non-drug.For example, several research teams are working on the creation of special gadgets for fast falling asleep and sound long sleep. The authors of one of the devices are employees of the Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences. This is a small black cube with a side of ten centimeters, inside there are three coils, which are supplied with a pulse current of a certain frequency. A weak electromagnetic field arises, which, acting on the brain, naturally regulates circadian rhythms.
The device has already shown its effectiveness in a small group of healthy volunteers. Whether he will be able to cure those suffering from chronic insomnia is not yet clear.
Scientists from Sechenov University, together with colleagues from Switzerland, are developing the first program of cognitive-behavioral therapy for insomnia in Russian.
“Most often, a person gets insomnia because he begins to worry about his sleep, behave incorrectly. He fixates on his problems and cannot get rid of them.Now there are certain methods of cognitive-behavioral therapy, but it takes a lot of time, competent specialists are needed, and in Russia, and in the whole world, there are very few such people. Now we are just working on a method of distance cognitive-behavioral therapy, so that a person, without a visit to a psychotherapist, from any part of our country, online, can go through these sessions. According to a thesis written at our university, the effectiveness of a two-week course is 28 percent.According to the estimates of foreign authors who wrote about the six-week treatment, the effectiveness of cognitive-behavioral therapy reaches 60 percent. This is comparable to the effectiveness of treatment with traditional sleeping pills. But the advantage of the psychological method is that its effect is not lost after stopping treatment. But after refusal from sleeping pills, sleep disorders always return, since the main cause of these disorders is not eliminated, “Poluektov concludes.
March 15, 2019, 08:00Scientists told how to properly deal with insomnia 90,000 treatment, causes, symptoms, how to deal with insomnia in the elderly, children, adults.
Insomnia , or, in medical terms, insomnia , is one of the mass diseases in the world. Insomnia statistics are growing every day. Today, 29% of men, 37% of women, 25% of children and 75% of pregnant women suffer from this disease. Insomnia is expressed by disturbed sleep.Patients do not always take insomnia seriously and let its treatment take its course. This attitude leads to unpleasant and dangerous consequences in the form of the transition of the disease into a chronic form, neurological disorders, pathologies of internal organs and mental disorders. Not everyone can cope with insomnia on their own, and in most cases, the help of a medical specialist is needed to get a good result. Insomnia, or insomnia, is a disturbance in the quality and quantity of sleep that negatively affects a person’s daily life.The concept of insomnia includes intermittent sleep (a person often wakes up), problem falling asleep (a person cannot fall asleep for more than half an hour) and the lack of effectiveness of night sleep (a person does not feel rested during the day).
Sleep is extremely important for human health, because it is at this time that the human body recovers its strength. The average person needs 6 to 10 hours of sleep. People spend a third of their lives in a dream, and this is completely justified. When we sleep, our brain processes the information received, subconscious and conscious elements work, both types of memory (short-term and long-term) and behavioral characteristics of the body are formed.A person cannot survive without sleep for more than 200 hours. Without sleep, people become lethargic, their emotions and reactions disappear, and their immunity decreases.
Causes of insomnia
The causes of insomnia are numerous. These include mental and physical illnesses, emotional ups and downs, medications, bad habits and overeating before bedtime. Among the diseases that provoke insomnia are parkinsonism, hyperthyroidism, depressive disorders, neurosis, kidney disease and arthritis.Frequent human experiences associated with everyday, work and global problems also negatively affect healthy sleep. Let’s highlight the most common reasons for the development of insomnia in people: mental disorders and increased emotional experiences, pathologies of the endocrine system, somatic diseases, apnea, bad habits (alcohol, tobacco, drugs), neurology, side effects of drugs, pain, external irritants, night work and changing time zones.
The reasons for the development of insomnia can be the individual characteristics of the patient.These include the patient’s age, temperament, current health status, and lifestyle. The most susceptible to insomnia are the elderly, women and people in difficult life situations.
Insomnia manifests itself in problem falling asleep, restless sleep with frequent awakenings, after which it is impossible or difficult to fall asleep, and daytime apathy and fatigue. The symptoms of insomnia are bright and easily identifiable. During the day, signs of insomnia manifest as irritability, lethargy, decreased attention span, absent-mindedness, and mood swings.All this leads to social dysfunction of a person due to the fact that the symptoms of insomnia cause a decline in motivation for anything. People suffering from insomnia do not feel sleepy during the day. Headaches and problems with the work of the gastrointestinal tract are often observed.
Fight against insomnia
There are household methods for dealing with insomnia. To win this “battle” you will need to master the following rules:
- Observe the correct diet and do not overeat before bed.Dinner should be taken at least 3 hours before bedtime.
- Avoid taking alcohol and caffeinated drinks before bedtime.
- Ventilate the room in which you sleep.
- Evening walks help you fall asleep faster.
- Do not get carried away with watching TV or working at the computer before bed.
- Find a comfortable pillow and mattress.
- Set aside time for naps if needed.
- Normalize work and rest hours.
Compliance with these simple rules helps to normalize sleep and maintain health. If this does not help to cope with insomnia, then the help of medical specialists is needed.
One of the methods for diagnosing insomnia is the Epworth scale. This scale rates sleepiness from zero to four. The patient is asked questions and points are calculated based on the answers. To rule out serious diseases, doctors conduct a detailed examination and examination.Insomnia can be severe or mild. To plan treatment, the doctor must identify the causes of insomnia and begin to eliminate them.
Types of insomnia
Insomnia according to the DSM-IV classification of mental disorders is defined as unsatisfactory quality and quantity of sleep that bothers the patient at least three times a week for a month. During nighttime sleep, specialists distinguish between REM and non-REM phases. The first is the rapid eye movement phase. The second is divided into 4 periods, the last two of which are called the slow-wave phase or d-sleep.It is during this phase that deep sleep occurs, restoring the strength of the body. The International Classification of Sleep Disorders defines insomnia as dyssomnia. Dyssomnia is a broader concept than insomnia. It includes difficult falling asleep and unstable sleep (in fact, insomnia) and hypersomnia (increased feeling of sleepiness).
Physicians isolate endogenous and external insomnia. The latter is insomnia due to poor sleep hygiene, the use of psychoactive substances and stressful conditions.Endogenous insomnia includes: psychophysiological and idiopathic insomnias, obstructive apnea, restless legs syndrome, circadian rhythm disturbances and non-standard work regimes. Psychophysiological insomnia is caused by short-term stress and lack of sleep. Circadian rhythm disturbances can occur with REM sleep or slow-wave sleep disorder. REM sleep disorders are more common in older people, and REM sleep disorders are more common in young people.
Somnologists distinguish adaptive, psychophysiological, idiopathic, behavioral insomnia on the basis of mental disorders, sleep hygiene disorders, concomitant somatic diseases, medication intake and pseudoinsomnia.Let’s take a closer look at the types of insomnia:
- Adaptive, or acute insomnia develops due to severe stress and lasts no longer than 3 months.
- With psychophysiological insomnia, the patient has a fear of not being able to fall asleep, and by the evening a general feeling of tension grows.
- Idiopathic insomnia usually develops in childhood.
- Behavioral insomnia inherent in children develops on the basis of incorrectly laid down attitudes.Thus, a child may have insomnia only because he is not used to falling asleep without motion sickness, for example.
- Insomnia is a common symptom of mental illness. In percentage terms, insomnia in mental patients is 70% of cases.
- Insomnia due to poor sleep hygiene is most common due to people’s inattention to their health and sleep.
- Many diseases of a somatic nature provoke insomnia (arrhythmia, pain in peptic ulcer disease, etc.)etc.).
- Misuse of medicines, including sleeping pills, can cause insomnia. Alcohol also provokes insomnia.
- Pseudoinsomnia is a disorder in which a person’s perception of the duration and quality of sleep is impaired. Pseudo-insomnia patients think they sleep much less than they actually do.
Insomnia in a child
Children’s insomnia is behavioral and psychophysiological, and can also be associated with the use of drugs and the presence of somatic diseases.Common causes of insomnia in children are pain of various origins, reflux, otitis media, seizures and other conditions. Behavioral insomnia occurs in 30% of preschoolers. It is subdivided into violations of associations and inferiority of the work of the restraining mechanism. The latter category can be manifested by the child’s refusal to go to bed at the proper time.
A medical specialist should deal with the treatment of insomnia, since illiterate self-medication can lead to unpleasant consequences.For example, unjustified intake of sedatives and sleeping pills can cause an addictive effect, intoxication, and negatively affect the work of internal organs and systems. Most importantly, self-medication can harm health without eliminating the problem itself. A person with insomnia can help themselves in terms of observing some rules called sleep hygiene. In addition, there are non-traditional treatments for insomnia such as psychotherapy , encephalophony and herbal medicine . Let’s take a closer look at them.
A psychotherapist will help the patient cope with insomnia due to stress, anxiety and nervous disorders. The doctor teaches the patient to change their attitude to the problem. We can say that this is the solution to the psychosomatics of insomnia. Encephalophony is a rare method in our country, as it requires certain equipment. The procedure itself consists of converting electrical signals of brain activity into the sounds of music, which the patient then listens to.
On the contrary, herbal medicine has become a very common method of fighting insomnia.Examples of herbs with sedative and hypnotic effects are lemon balm, mint, and valerian.
With regard to drug treatment , today there is a wide range of drugs that affect sleep. On the one hand, this is a plus, because there is plenty to choose from, but on the other, there remains the problem of selecting an individual ideal remedy for insomnia. A good drug should support sleep during the night, have minimal residual sleepiness and not interfere with daily activities of a person, as well as have minor side effects and not provoke addiction.When taking sleeping pills, you need to know some precautionary rules. You should take herbal medications, such as Persen, or melatonin-based medications, such as Melaxen. You can take sleeping pills for no more than 20 days. The composition of drug treatment, in addition to hypnotics, includes sedatives, tranquilizers-benzodiazepines and melatonin-based drugs.
Synthetic sleep hormone – melatonin – regulates sleep in cases of chronic insomnia.Melatonin is permitted in dosages up to 5 mg. This hormone is part of the drug Melarithm, which is prescribed for insomnia after 50 years. It is allowed to take such funds for no more than three weeks. An important feature of melatonin is its ability to interact with LH (luteinizing hormone), so it should not be given to girls during puberty and women during pregnancy.
Another method of insomnia therapy – hypnosis . Hypnotic treatment for insomnia can be carried out after the patient reaches the age of five.
Insomnia in women is often observed during menopause. In this case, women have a desire to sleep during the day and cannot sleep at night. In case of insomnia during menopause, it may be necessary to consult an endocrinologist-gynecologist. As a rule, the drugs of choice for insomnia with menopause are phytoestrogen-based drugs. In old age, insomnia is also common. Often at this age, insomnia can be confused with high fatigue, due to which people sleep during the day, and at night they can no longer fall asleep.In order to sleep better, older people may benefit from drinking warm milk before bed or taking an herbal bath. Insomnia often develops against the background of alcohol intoxication. This is due to the negative impact of alcoholic beverages on the central nervous system and the provocation of oxygen starvation. Insomnia from alcohol should be treated as recommended by a narcologist. It is such a specialist who should prescribe pills for insomnia to addicted people. Insomnia in children can be associated with an unsteady nervous system and sleep rhythm.Insomnia in newborns can be triggered by colic, food cravings, temperature fluctuations, and stress. Older children may suffer from insomnia due to travel and change of place of residence or study, the presence of worms and painful sensations of any genesis.
There are homeopathic remedies for insomnia. Among them, the following funds can be distinguished:
- Aconite – used at high temperatures against the background of insomnia;
- Chilibukha – prescribed for increased irritability;
- Ignation – successfully used for depression and anxiety, including states after the loss of loved ones.
treatment in sanatoriums has a beneficial effect on the patient’s condition with insomnia. Such treatment is prescribed by a doctor after a complete examination of the patient. The main condition of the spa treatment is the cessation of smoking, alcohol and drugs, adherence to the established regime of the day and sleep. For therapy in sanatoriums, special herbal teas for insomnia, massages, physiotherapy, physiotherapy exercises and outdoor recreation are used.
Home treatment for insomnia
There are many recipes for home treatments for insomnia on the internet.It is necessary to start taking them as a treatment with the permission of the attending physician. Here are some examples of similar recipes:
- Dried bay leaves added to pillows to improve sleep.
- Eating onions before bedtime.
- Cahors with the addition of dill seeds. This mixture is cooked for about 20 minutes, infused for an hour and taken before bedtime for 50 g.
- Valerian tincture. To prepare such an infusion at home, you need to pour a tablespoon of valerian with boiled water and leave for 7 hours.You need to take this remedy in a tablespoon 3 times a day. The duration of taking valerian infusion has limitations, and it is necessary to consult a doctor. In addition to valerian, you can use motherwort for insomnia, or Glycine tablets.
Non-drug treatment for insomnia
Non-drug treatments for insomnia include stimulus-control and cognitive therapy, paradoxical intentions, relaxation, imaginative psychotherapy, and sleep control methods.Stimulus-controlling psychotherapy is based on the fact that a person should associate a bed with sleep, and not with watching TV, for example. According to this method, the cause of insomnia is the misconnection of associations. For the effectiveness of this method of treatment, psychotherapists advise not to be in the bedroom if you have not been able to fall asleep, but, on the contrary, to leave it and return only with a certain desire to sleep. By repeating this procedure, the body develops the habit of falling asleep in the bedroom.The technique of paradoxical intentions and cognitive therapy are based on combating their own fears of insomnia and the experiences associated with them. Muscle relaxation helps to normalize sleep, but is inferior to stimulus-control techniques. Figurative psychotherapy helps to cope with problem sleep by stopping thoughts on pleasant memories or images.
Massage and gymnastics for insomnia
One of the pleasant and safe methods of insomnia treatment is massage.So, foot massage can be mastered and applied at home for 20 minutes twice a day. Reflex massage has no contraindications. In the fight against insomnia, Chinese gymnastics can be a good helper. Gymnastics for insomnia is carried out 10 minutes before bedtime and includes a massage of the head, ears, neck, abdomen and feet. On the Internet, you can find video tutorials on carrying out such gymnastics.
Breathing exercises before bedtime will help you fall asleep faster. Rhythmic breathing has a positive effect on the abdominal muscles, stabilizes the digestive tract and blood supply to the brain.Breathing exercises are great not only for young people, but also for older patients with insomnia. You cannot immediately do a large complex of breathing exercises, the load should be reasonable and enjoyable. When doing the exercises, remember that you need to breathe through the nose and exhale should be longer than inhalation. Breathing should be rhythmic, for this you can mentally count. Meditation has a similar beneficial effect.
Mudras for insomnia
In terms of energy, healthy sleep is primarily a healthy energy exchange.The mudra for insomnia can be done at home. To do this, you need to turn to face the east and tune in to relaxation. The hands should be crossed on the chest (upper right hand), and the fingers should be folded into a special position called mudras. With insomnia, the mudras “Strengthening the nervous system” and “Knowledge” will be successful.
It will be useful to know that there are sleep dots on the hands. They will help normalize sleep in case of insomnia. Sleep points are located symmetrically: in the corners of the nails of the little fingers, under the elbows on the outside and in the area of the fold between the thumb and forefinger.
Consequences of insomnia
During sleep, the level of anabolic processes in the human body increases, and in the late afternoon, the sleep hormone melatonin begins to be produced. It is he who makes us want to sleep. In a state of drowsiness, brain activity decreases, namely: we observe distraction of consciousness, yawning and slowing of the pulse. With sleep disorders, it is difficult for a person to fall asleep quickly. In the morning, such people rarely feel rested. Chronic insomnia can be a consequence of such violations.In the future, this condition can cause complications in the form of mental disorders, shortness of breath, leg cramps at night. Sleep problems in the case of insomnia can raise blood sugar levels and trigger arrhythmias, not to mention chronic fatigue and loss of attention. Restless sleep causes depression and worsens a person’s quality of life. Therefore, it is important not to trigger insomnia, but to start fighting it in time, preventing complications from developing.
Medicines for sleep disorders in people with dementia
What Difficulties Do Sleep Disorders Associated With Dementia Cause?
People with dementia often suffer from sleep disorders.This manifests itself in the form of a decrease in the time of night sleep, frequent awakenings after falling asleep, wandering at night, waking up early, sleeping too long during the day.
This behavior causes a lot of stress for carers and may be associated with earlier admission to institutions for people with dementia. This behavior can also make it difficult for domestic staff to care for the person with dementia.
Can medicines help?
Medication is often used to try to improve sleep in people with dementia.Since the sources of sleep problems can be changes in the brain caused by dementia, it is not clear whether sleeping pills will be effective for people with dementia, and there are concerns that the medications could cause serious side effects (harm).
Purpose of this review
In this updated Cochrane Review, we have attempted to identify the benefits and common harmful effects of any drug used to treat sleep disorders in people with dementia.
Results of this review
We searched the medical literature up to March 2016 for all randomized trials that compared placebo (dummy drug) and any drug used to treat sleep disorders in people with dementia. We found six trials (326 participants) that examined three drugs: melatonin (four studies), trazodone (one trial), and ramelteon (one trial). The ramelteon test and one melatonin test were commercially funded; the remainder of the trials had non-commercial funding sources.Information was limited in the ramelteon trial and was provided by the research sponsor. Overall, the data were of low quality, which means that further research is very likely to influence the results.
Nearly all of the participants in the melatonin and trazodone trials had moderate to severe dementia, while the participants in the ramelteon trial had mild to moderate dementia.
The four melatonin trials enrolled a total of 222 participants.Based on the evidence we found, we could be reasonably confident that melatonin did not improve sleep in people with Alzheimer’s dementia. There were no reports of any serious harm.
Thirty people participated in the trazodone trial. This study was so small that we could only have limited confidence in its results. It showed that a low dose of the sedative antidepressant trazodone, 50 mg taken at bedtime for two weeks, increased total nighttime sleep by an average of 43 minutes.This drug improved sleep efficiency (the percentage of time spent sleeping in bed), but did not affect the time spent awake, after falling asleep, or the number of participants waking per night. There were no reports of any serious harm.
74 people participated in the trial of the ramelteon. The limited information available did not provide any evidence that ramelteon was better than placebo. There were no reports of any serious harm caused by the ramelteon.
Trials did not report some of the outcomes / outcomes we were interested in, including information on quality of life and impact on carers.
Disadvantages of this review
Although we searched, we were unable to find any trials of other sleeping pills that are commonly prescribed for people with dementia. In all participants, dementia was caused by Alzheimer’s disease, although sleep problems are also common in other forms of dementia.
We conclude that there is very little evidence to guide drug decisions for sleep disorders in people with dementia. Any medication should be used with caution, with a careful assessment of how well it works and what its side effects are in individual patients. More trials are needed to inform medical practice, in particular clinical trials of drugs that are commonly used for sleep disorders in people with dementia.It is imperative that trials include a careful assessment of side effects.
How do they work and how to choose a cure for insomnia?
A doctor diagnoses insomnia if a patient has been complaining of a lack of sleep or poor quality sleep for a long time. Difficulty falling asleep, frequent awakening in the middle of the night, feeling tired and sleepy during the day – these signs, which appear for no objective reason, indicate a problem that often requires taking medication.When does a doctor prescribe a medication for insomnia? How to understand that it is necessary? What remedy can help restore sleep without harming your health? In our article you will find answers to all these questions.
The Importance of Combating Sleep Disorders
Those who suffer from insomnia need not be told how it poisons existence. If you often have difficulty falling asleep, wake up at night and cannot fall asleep again, no matter how hard you try, and in the morning you feel as if you have not slept at all, then all this is already enough for life to cease to bring its former joy.A person suffering from insomnia every day feels such fatigue and weakness that he has no strength left for work, hobbies, or communication with loved ones.
But that’s only half the trouble. Long-term sleep disorder does not pass without leaving a trace for the body and entails a number of serious disorders:
- Against the background of insomnia, brain activity decreases, memory deteriorates and attention weakens. It is difficult for a person to concentrate on work and daily activities. Scientists attribute this to damage to brain cells due to oxidation (the so-called oxidative stress) .In addition, in a dream, the process of sorting the information received during the day takes place: important information is stored in long-term memory, the rest is “erased”. If you don’t get enough sleep, your brain cannot process the data, and this negatively affects cognitive functions.
- Chronic lack of sleep is bad for the psyche. A person suffering from insomnia becomes irritable, anxious, neuroses and depressive disorders develop.
- Constant sleep deprivation is detrimental to the cardiovascular system.People with insomnia are at high risk of atherosclerosis and hypertension. They are also more likely to have a heart attack or stroke than those who do not have difficulty sleeping.
- Insomnia leads to weight gain. This phenomenon has two reasons. Firstly, with a lack of sleep, metabolism slows down, which means that energy expenditure decreases. Even eating as before, you gain weight. Secondly, it has been repeatedly observed that a lack of sleep provokes an increase in appetite. Together, these two factors can lead to obesity.
- Another consequence of chronic insomnia is a decrease in immunity. People who sleep less than normal are more susceptible to colds. This fact can be explained by a decrease in the production of protective proteins, cytokines, which are synthesized in the body just during sleep.
- Studies  have shown that with constant lack of sleep, insulin resistance occurs more often, therefore, the risk of developing type II diabetes mellitus increases. The risk is especially high if the person with sleep problems is overweight.
- Chronic lack of sleep leads to premature aging and has an extremely negative effect on appearance. In a dream, the body rests and recovers. If you do not give him this opportunity, the consequences will not be long in coming. After the first sleepless night, bruises appear under the eyes, and wrinkles become more noticeable. When unhealthy sleep becomes systematic, the aging process accelerates rapidly.
If you complain about poor sleep more than two to three times a week, it’s time to take action.You should start by eliminating the visible causes. The most common of these are stress and disruption. Certain diseases can also lead to insomnia. If your physical health is okay, pay attention to sleep hygiene:
- try to go to bed at the same time;
- Use a comfortable mattress, pillow and bedding made from natural fabrics;
- Before going to bed, ventilate the bedroom, and if the weather permits, open the window at night;
- Do not drink coffee or strong tea in the afternoon;
- Eat dinner no later than three hours before bed and avoid overeating;
- Do not use alcohol to fight insomnia: the effect will be exactly the opposite – you will fall asleep quickly, but not for long;
- Take care of your nervous system: do not watch action films and thrillers before going to bed, do not read disturbing news, if possible, finish all work during the day and do not quarrel with loved ones.
Sleep hygiene is a must when dealing with insomnia, but this alone is rarely enough, especially when the problem has been present for several years. So if the listed measures did not bring the desired result, the next step should be a visit to the doctor – first, to a therapist, who, if necessary, will refer you to a narrow-profile specialist.
First of all, the doctor must conduct an examination to find out the cause of insomnia. Depending on this, treatment will be prescribed.For example, if sleep disorders are due to a physical or mental illness, therapy should be aimed at eliminating it. If emotional stress is at the root of insomnia, a very different treatment will be needed.
In the fight against sleep disorders, non-drug therapy and pharmacological agents are used. These methods are often used in combination. Among the non-drug methods of treating insomnia, various methods of psychotherapy (cognitive-behavioral therapy, auto-training, hypnosis), muscle relaxation, meditation, and yoga exercises can be effective.Yet non-drug methods are rarely used in isolation: they usually complement the intake of pharmacological drugs.
Types of drugs prescribed for insomnia
Drugs for insomnia are diverse in origin, principle of action and form of release. Depending on the cause of the sleep disorder, the severity of the condition, the accompanying symptoms, the doctor will prescribe one or another remedy or a combination of them. When taking any medicine, strictly follow the recommended dosages: even herbal remedies for insomnia can be harmful if used uncontrollably.
To make it easier for you to navigate in the variety of medicines, we offer their conditional classification according to three main characteristics.
Form of issue
Medicines for insomnia are produced in the form of drops, tablets and brewing sachets. The ease of use and the bioavailability of the drug depend on the form of release.
Tablets are one of the most common dosage forms due to their convenience.In addition to the active ingredient, any tablet also contains excipients necessary to give it the desired volume, taste and other properties.
Drops are, as a rule, a solution of the active substance in water or alcohol tincture. The form is convenient in that it allows you to easily and accurately measure the required dose.
In the form of a sachet, vegetable preparations are most often produced. Crushed medicinal herbs in paper filter bags are boiled and infused. The active ingredients contained in the plants are transferred into the infusion.
Principle of action
The choice of drug depends on the cause of the sleep disorder. Sometimes insomnia occurs against the background of a disease. Then medications are prescribed to eliminate the underlying cause. Once the illness that caused the insomnia is cured or in remission, normal sleep restores itself.
The list of diseases associated with sleep disorders is very long. Accordingly, the drugs will differ in their principle of action.So, if the disease proceeds with a pronounced pain syndrome that does not allow sleep, pain relievers are prescribed. If sleep disturbance is associated with endocrine disorders (for example, hyperthyroidism), hormonal drugs are used. For depression and anxiety disorders, a psychotherapist may prescribe tranquilizers and antidepressants to normalize the general condition, including to restore sleep.
Primary, that is, unrelated to the disease, insomnia is treated with drugs that act to increase the duration and improve the quality of sleep.Prescribe drugs of two groups – sedatives and hypnotics.
Sedatives , or sedatives, means relieve anxiety, reduce nervous tension – they are indicated for insomnia caused by psychoemotional stress. Sedatives usually do not have a direct hypnotic effect (although it can be done with increasing doses). Sleep is normalized by reducing anxiety and anxiety.
Natural nonprescription herbal remedies are widely represented among sedatives.These are non-addictive insomnia medications with mild sedative properties. Of the synthetic drugs of sedative action, bromides are most often used.
As a symptomatic remedy for insomnia, drugs from the category hypnotics are prescribed. They, in turn, are classified according to the principle of action into several types. The most common group is drugs that act on the receptors for gamma-aminobutyric acid (GABA), which is the main inhibitory neurotransmitter.These include, in particular, barbiturates, which are now practically not used due to the narcotic effect. Another type of hypnotic drug that targets GABA receptors is benzodiazepines. They also have a wide range of contraindications and side effects, up to physical dependence. In modern medicine, for insomnia, drugs of the latest generation are used – non-benzodiazepine hypnotics.
This is important
Any hypnotics should be taken with great care and only for a short time (the duration of the course will be determined by the doctor).With their long-term use, side effects are possible in the form of dizziness, drowsiness throughout the day, memory and attention disorders. Some drugs with sleeping pills can be addictive, and then without the drug a person will not be able to sleep at all.
There are natural and synthetic remedies for insomnia. The advantages of the former are a minimum of side effects and contraindications. Medicinal plants, such as motherwort, valerian, lemon balm, have a mild sedative effect, reduce anxiety and irritation.Herbal medications for insomnia, as a rule, are not addictive, and they can be used for a long time. Synthetics are more potent, but they often have unwanted side effects. These drugs are prescribed for short courses for severe sleep disorders.
What to look for when choosing a remedy
What drugs to take for insomnia is determined by the doctor. But it is also useful for patients to understand the issue. So, when choosing a drug, you should pay attention to the following points:
- Active ingredients.Where possible, preference should be given to natural herbal remedies that do not contain phenobarbital. If you cannot avoid taking sleeping pills, then it is better to choose the latest generation drugs without benzodiazepines and barbiturates.
- Contraindications and side effects. Naturally, it is worth choosing a medication for insomnia that is not addictive and has no other undesirable effects. Study the list of contraindications and make sure that they do not apply to you.
- Interaction with other drugs.This point applies to those who are taking other medications for the treatment of concomitant diseases.
- Course duration. Some drugs are intended for long-term use, while others have a quick effect and are used for a short time. The latter usually refers to sleeping pills. The main rule here is: do not exceed the recommended course duration.
In the treatment of insomnia, medications and non-medications can be equally important: they work in combination and complement each other.Therapy will be ineffective if you violate the rules of sleep hygiene, but just adherence to the regime can rarely solve a neglected problem. When choosing drugs, it is important to balance the expected benefits and the possible risks.
On the possibility of using sleeping pills for a long time
The National Institutes of Health Consensus on the Treatment of Chronic Insomnia (2005) indicated the possibility of prescribing certain benzodiazepine receptor agonists for a longer period than was previously recommended.This is due to the accumulation of data on the effectiveness and safety of long-term use of modern non-benzodiazepine hypnotics, such as eszopiclone and ramelteon (not registered in Russia). In addition, chronic insomnia currently involves long-term or lifelong treatment, including non-drug and pharmacological approaches to prevent recurrence. This can lead to a longer time frame for prescribing sleeping pills for chronic insomnia.
Table 1.Phenomena associated with long-term use of certain psychotropic drugs
Table 2. Criteria for dependence on drug intake, according to the classification of DSM-V
In the instructions for many psychotropic drugs, there is often a cryptic recommendation to use the drug for no longer than three to four weeks. Faced with such a formulation, the doctor is not surprised, because he knows from the course of pharmacology about the problems of addiction and drug dependence.Barbiturates and benzodiazepines are commonly cited as examples of drugs that are associated with these phenomena. It remains unclear what the recommended duration of admission is based on. The doctor may assume that there have been studies specifically devoted to this topic. Is it so?
First of all, you should decide on the conceptual apparatus used. The main definitions for the phenomena associated with long-term use of psychotropic drugs are given in table. 1 and are discussed below.
Is there a problem with psychotropic drug abuse? Yes, there is. In 2014, the United States registered 21.5 million people who abuse psychoactive substances, of which 17 million were alcohol, 1.9 million were tranquilizers, and 0.7 million were sedatives . For sleeping pills, such abuse involves at least one use of them without a doctor’s prescription. Among patients with chronic insomnia, 22% take alcohol as a sleeping pill .According to the Russian continuous population study, which involved more than 1500 people, episodic or frequent sleep disturbances were observed in 20% of the population, while the prevalence of the use of sleeping pills was comparable – 18.7% .
Most of the unwanted side effects of psychotropic drugs are due to long-term use. There is no consensus in the medical literature on what to mean by long-term.In 1996, the World Health Organization recommended that the use of the drug be considered long-term for at least six months a year . A similar opinion is shared by the authors of later reviews on this topic .
According to the fifth version of the classification of mental disorders (Diagnostic and Statistical Manual of Mental Disorders – DSM-V), drug or alcohol dependence is considered to be their use, despite the developing negative consequences .Compulsive and repeated use of the drug can lead to the development of addiction and withdrawal symptoms after stopping the drug or reducing the dose. The complete criteria for this condition are given in table. 2.
The concept of addiction as a special case also includes the concept of addiction (tolerance) – a decrease in the effectiveness of the drug taken and the need to increase its dose to achieve the same effect.
When discussing the phenomena of addiction, the concepts of physical and psychological addiction are also used.Physical dependence develops when structural changes occur in the human body during the use of the drug. Most often, this is realized at the receptor level, when the phenomenon of desensitization of receptors is noted, accompanied by a decrease in their number against the background of excessive stimulation. In addition to the acute withdrawal syndrome, physical dependence is also characterized by the development of a subacute withdrawal syndrome, accompanied by an undulating course with an increase and decrease in symptoms, sometimes over several years.Psychological dependence implies the development of emotional and motivational disorders in the structure of the withdrawal syndrome. For example, a feeling of dissatisfaction, insecurity, a decrease in the ability to receive pleasure (anhedonia), or an increase in the general level of anxiety. In case of psychological dependence, the drug is taken not for pleasure, but in order to avoid unpleasant sensations when it is canceled.
Sleep disorders, along with chronic pain and mental illness, are one of the leading conditions associated with the development of drug dependence.This is usually discussed using the example of hypnotic benzodiazepine derivatives, over half a century of use of which a great deal of clinical experience has been accumulated.
Orally taken benzodiazepines are rapidly absorbed in the gastrointestinal tract and peak blood concentrations after about an hour. These drugs bind well to proteins and are distributed throughout the body within seven to ten hours, metabolized in the liver and completely eliminated from the body within two to six days.Benzodiazepines have an inhibitory effect on the central nervous system (especially on the limbic system of the brain), increasing the inhibitory effect of gamma-aminobutyric acid (GABA) on specific receptors (GABA A -receptor complex) .
Tolerance to benzodiazepines develops through several mechanisms, which makes this phenomenon clinically heterogeneous:
- Change in the configuration of the GABA A -receptor, in particular, the separation of the benzodiazepine-binding and GABA-binding subunits, which leads to blocking of the binding of the receptor to GABA;
- Decrease in transcription of genes responsible for the synthesis of benzodiazepine-sensitive subunits of GABA A receptors by the mechanism of negative feedback;
- Increased sensitivity of glutamatergic receptors as a response to the activation of GABA receptors;
- Changes in the balance of other neurotransmitters (dopamine, serotonin, acetylcholine) and neurosteroids, which have a modulating effect on GABA receptors, due to the nonspecific effect of benzodiazepines on other cells .
The genetic prerequisites for the development of tolerance to sleeping pills were studied. The presence of a congenital predisposition is confirmed by both clinical observations and genetic studies. In an experiment on mice, a gene was identified that is responsible for the synthesis of brain-specific angiogenesis inhibitor 1-associated protein 3 (BAIAP3) associated with brain-specific angiogenesis inhibitor 1. This gene is expressed by cells of mouse brain regions involved in fear responses (tonsils, hypothalamus, periaqueductal gray matter) and behavioral responses corresponding to human anxiety responses .Protein BAIAP3 is involved in the synthesis of membranes of synaptic vesicles containing glutamate and GABA. Mutations of the genes involved in the synthesis of GABA receptor subunits – h201R (alpha-1 and alpha-2 subunits), h226R (alpha-3), h205R (alpha-5) reduce the sensitivity of receptors to benzodiazepines while maintaining sensitivity to GABA.
Drug tolerance develops at different times in relation to the various effects of benzodiazepines: first of all, to sedative, muscle relaxant, and then anxiolytic.Addiction to benzodiazepines is characterized by disturbances in the circadian rhythm of the sleep-wake cycle with nocturnal awakenings and the inability to fall asleep without taking another dose of the drug.
Abrupt cessation of the use of sleeping pills, taken for a long time, causes withdrawal symptoms (withdrawal symptoms) lasting from several days to two to three weeks, and in some cases up to three to six months. Withdrawal syndrome is a group of mental and somatoneurological symptoms not previously observed.The former include irritability, dysphoria, tension, depressed mood, a significant increase in anxiety and anxiety, agitation or, conversely, lethargy, increased fatigue, depersonalization, and severe sleep disorders, often with nightmares caused by a rebounding increase in REM sleep. Somatoneurological disorders include autonomic disorders: hyperhidrosis, tachycardia, hypotension, hypopnea, and sometimes hyperthermia. Anorexia, nausea, vomiting are possible.Neurological symptoms are represented by dizziness, headache, small-sweeping tremor of the fingers, fibrillation of the tongue, impaired coordination of movements, vision, and difficulty speaking. Changes in heart rate and blood pressure, in turn, can provoke myocardial ischemia or arrhythmia, therefore, at the first signs of withdrawal syndrome, the doctor should be ready to take measures to support blood circulation and respiration.
With the abolition of benzodiazepine hypnotics, the development of the phenomenon of rebound insomnia has also been described – a deterioration of both subjective and objective (increase in the proportion of REM sleep) sleep characteristics in the following one or two nights after the cancellation.Further, sleep indicators either return to the level that was achieved while taking the drug, or worsen somewhat, usually not dropping below the level that was before treatment. Unlike withdrawal syndrome, rebound insomnia does not cause new symptoms.
In a meta-analysis of studies on the efficacy of benzodiazepine hypnotics, it was shown that the use of these drugs, according to polysomnography, was accompanied by a decrease in the time to fall asleep by an average of 4.4 minutes (95% CI 0.7–9.2) and an increase in total sleep time by 61.8 minutes (37 , 4–86.2) .Patients’ subjective reports turned out to be more optimistic: the time to fall asleep decreased by 14.3 minutes (10.6–18.0).
There are no meta-analyzes of long-term use of benzodiazepine hypnotics for addiction and addiction symptoms. Some articles mention only a study with a two-month use of temazepam for insomnia, which was not accompanied by the development of addiction and dependence . Some experts have estimated the incidence of dependence when taking benzodiazepines as sleeping pills at 20% .
The non-benzodiazepine ligands of the GABA A -receptor complex include drugs that do not have a benzodiazepine element in their structure (a combination of benzene and diazepine rings), but exhibit an affinity for the attachment sites of benzodiazepines. These are the so-called Z-drugs: zopiclone (cyclopyrrolone derivative), zolpidem (imidazopyridine), zaleplon (pyrazolopyrimidine). The action of these substances has such a feature as maximum affinity for the alpha-1-subunit of this receptor complex, which is responsible for hypnotic action, with minimal affinity for the binding sites responsible for other undesirable effects of benzodiazepines.
Compared to most benzodiazepine hypnotics available, Z-drugs have a fairly short half-life (from a minimum of one hour for zaleplon to a maximum of five hours for zopiclone). Z-drugs cause fewer daytime side effects than benzodiazepines and are therefore preferred for nighttime sleep complaints. Nevertheless, there are reports of the development of such side effects as hallucinations and psychosis, complex behavioral reactions while taking these drugs, especially zolpidem.Z-drugs do not use the mechanisms of addiction development that are characteristic of less selective benzodiazepines . S. Ancoli-Israel et al. (2005) noted a significant improvement in the time to fall asleep, an increase in the duration of sleep and the number of nocturnal awakenings with the use of zaleplon for one year in elderly patients with insomnia. At the same time, the development of the effects of addiction and dependence was not observed, a distinct effect of rebound insomnia was determined within two to five days after discontinuation of the drug .There are isolated reports of the development of addiction to highly selective hypnotics .
The most modern of the Z-drugs, eszopiclone (a stereoisomer of zopiclone) and a sustained-release form of zolpidem (not registered in Russia) are recommended for long-term use in the treatment of insomnia. In a six-month study by J. Walsh et al. (2007) eszopiclone demonstrated a positive effect on the insomnia severity index scale (mean score less than 7 was recorded in 50% of patients versus 19% in the placebo group) .At the same time, the effects of addiction and dependence on the background of taking the drug were not recorded.
Similar results were obtained in a group of elderly patients with insomnia who received treatment with eszopiclone for three months. On the background of taking the drug, the subjective indicators of the time to fall asleep, the total time of sleep and wakefulness during sleep improved. At the same time, there was no development of the effects of addiction, dependence and rebound insomnia .
In an eight-month placebo-controlled study, T.Roth et al. (2013) studied the efficacy of sustained-release zolpidem in chronic insomnia. While taking the drug, there was an advantage in the number of patients with “significant or noticeable improvement” (85% versus 48% in the placebo group) and the absence of the development of the effects of addiction and dependence . Similar results were obtained with a six-month application of this form of zolpidem according to the scheme “on demand” in the study by A. Krystal et al. (2008) .
The next generation of hypnotics is represented by melatonin receptor agonists.The pineal hormone melatonin has a mild hypnotic and much more pronounced chronobiotic (regulating circadian rhythms) effect. It has been shown that the hypnotic effect of melatonin increases with a decrease in its internal production. Meta-analyzes published in the Cochrane Database confirm the beneficial effects of melatonin preparations on falling asleep, duration and quality of night sleep .
The agonist of melatonin receptors of the first and second types ramelteon (not registered in Russia) has a half-life of one to 2.5 hours.In studies lasting up to five weeks, there was no evidence of the development of effects of tolerance and dependence on the background of taking this drug . It is emphasized that the intake of melatonin receptor agonists is not accompanied by a “reinforcing effect” and therefore does not cause psychological dependence. The drug has a proven effect only in terms of reducing the time to fall asleep, it does not affect other characteristics of sleep. In an open study by G. Richardson et al.(2009) used ramelteon for the treatment of chronic insomnia for one year, while the manifestations of withdrawal and addiction to the drug were not recorded .
A new target for the action of hypnotics is the orexin activating system of the brain, which is also responsible for the alternation of the phases of slow and REM sleep . In 2014, a drug that blocks both types of orexin receptors, suvorexant, was approved for use in the treatment of insomnia in the United States (not registered in Russia).It has shown beneficial effects on pre- and intrasomnic disturbances and early awakenings. Suvorexant does not suppress the respiratory center, which makes it safe for patients with severe obstructive sleep apnea and pulmonary pathology . In a placebo-controlled study, which was conducted for one year, the use of the drug was not accompanied by the development of addiction. After discontinuation of suvorexant, the development of negative side effects (withdrawal syndrome) and rebound insomnia were not observed .Currently, Suvorexant is the only drug for which there are systematized randomized data on the condition of patients after a year of use as a sleeping pill.
Separately, mention should be made of another drug widely used as a sleeping pill – a blocker of the histaminergic brain activating system. Doxylamine is a selective antagonist of the excitatory H 1 receptors, which are largely present in the brain.According to the results of open clinical trials without placebo control, doxylamine had a positive effect on subjective and objective sleep indicators in insomnia. Among them – a decrease in the time to fall asleep and the number of awakenings at night, the total duration of sleep, an improvement in the quality of night sleep and morning awakening, an increase in the duration of REM sleep . The only placebo-controlled, double-blind study in 1985 demonstrated a positive effect of the drug on subjective measures of sleep quality .Clinical use of doxylamine is limited by its M-anticholinergic properties, which makes it impossible to recommend it to people with glaucoma and benign prostatic hyperplasia.
A. Roussin et al. (2013) in a meta-analysis note that the formation of dependence and withdrawal syndrome with long-term use of the drug was absent. Only 1.3% of doxylamine-treated patients met the criteria for dependence. The authors, however, recorded the development of the phenomenon of rebound insomnia upon attempts to discontinue the drug .
So, back in 2005, experts from the US National Institutes of Health, in a consensus on the treatment of chronic insomnia, indicated the possibility of prescribing some benzodiazepine receptor agonists for a period longer than previously recommended . At first, this concerned only the new drug eszopiclone. Among other things, a low potential for the development of addiction was noted with short-term use of benzodiazepine receptor agonists and the lack of information on the consequences of their long-term use.
This consensus served as the basis for the development of clinical guidelines for the treatment of chronic insomnia, which were published in 2008 in the Journal of Clinical Sleep Medicine . These recommendations indicate the possibility of prescribing treatment with hypnotics for a long time in the presence of severe or refractory insomnia or chronic comorbid disease. The use of sleeping pills in the following modes has been described: on an ongoing basis (weekly), on an intermittent basis (for example, three times a week) or “as needed” (the level of recommendation is “consensus”, that is, level C on the standard scale of recommendations).The drugs of choice were benzodiazepine receptor agonists and ramelteon. At the same time, the duration of the use of sleeping pills was limited to two to four weeks. Certain categories of difficult patients (the authors could not more specifically designate this category of patients) were allowed to prescribe sleeping pills for a longer period, depending on the clinical experience of the doctor and the combined opinion of experts, since there is not enough data on the possibility of long-term use of sleeping pills.At the same time, the need for repeated visits of patients at least once every six months was noted to assess the effectiveness, register adverse events, addiction or abuse. It was also recommended to periodically try to reduce the dose of the drug. Cancellation of hypnotics to reduce the risk of rebound insomnia, according to the recommendations, should be carried out by gradually reducing the dose of the drug and the frequency of its administration.
More recent British Psychopharmacological Association recommendations 2010on the treatment of insomnia contain an interesting comment regarding the duration of the prescription of hypnotics for insomnia . Analyzing the recommendations of the US National Institutes of Health in 1983, the experts write: “This point of view is not based on research data showing a change in the ratio of ” risk – benefit “ in an undesirable direction after two to three weeks of treatment, on the fact that there have been no appropriate placebo-controlled studies of the use of hypnotics for more than a few weeks.Despite the fact that the recommendations for the use of sleeping pills specify a period of two to four weeks, millions of patients around the world continue to take the drugs on a regular basis. ” The following are data from studies, according to which, two years after the successful cancellation of sleeping pills, 40% of patients begin to take them again. This indicates the chronic remitting nature of insomnia and the possibility of using the same approach as in the treatment of depression . Thus, the recommendations of the British Association of Psychopharmacologists substantiate the possibility of long-term therapy with hypnotics with a level of evidence A.These clinical guidelines are also distinguished by a very low level (D) of the basis for the use of antihistamines for the treatment of insomnia and the initiation of treatment of insomnia in persons over 55 years of age requiring pharmacotherapy with prolonged-release melatonin .
So, there is no scientific evidence that the duration of sleeping pills should be limited to two to four weeks, as is usually indicated in the instructions for use.Data on the absence of the development of addiction and dependence phenomena with prolonged use of sleeping pills are also rather scarce. Nevertheless, chronic insomnia is currently regarded as a long-term current disease with a high risk of relapse, which allows international experts to recommend taking long-term sleeping pills. First of all, this applies to drugs of the latest generations: modified Z-drugs, melatonin agonists and orexin receptor antagonists.
90,000 Harm of sleeping pills: addiction and dependence
Medicines are usually prescribed by a doctor. Many sleep-balancing agents are available only with a prescription. Therefore, it is worth contacting a specialist before going to the pharmacy. The doctor will help determine the cause of the condition, advise on how to change your life so that everything will work out, and only as a last resort will prescribe some kind of pill.
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You need to understand that without eliminating the cause of the disease, it is very difficult to deal with the consequences.If sleep problems have arisen due to a stressful situation at work, in the family or in other groups, these circumstances need to be addressed. Sometimes it can be helpful to simply distract yourself or relax. A clear daily routine and adequate sleep time can help. To reverse anxiety, you need to stop drinking tea or coffee before bed, watching aggressive movies, and listening to heavy music. Sometimes it is enough to walk in the fresh air for 15 minutes to fall into the arms of Morpheus in a matter of minutes.
If all else fails, if the normalization of life does not work, it is worth starting with herbal sedatives. They do not cause negative consequences, do not contribute to addiction, but at the same time they give a very good effect. It is only important to remember that some of them cause some delay in reactions, so they cannot always be combined with driving a car.
Special drugs for insomnia can be dangerous.They can be taken only in the doses indicated by the doctor and not for too long a period of time. If you use these drugs regularly, addiction occurs. Sometimes a person chooses pills instead of changing his lifestyle, does not consult with a specialist, and then cannot live in peace.
The drug works for several weeks or months, and then its activity decreases. In order for the effect to continue, the dose is increased. This depresses the nervous system, affects the activity of the brain, which can cause serious illness.But the increase has to be done constantly. But if you take four instead of one tablet, poisoning occurs. If you use ten pieces, then death is possible.
In case of an overdose of the drug, falling asleep occurs, but sleep is difficult. The general state of non-sleep persists, but there is still a heaviness in the head during the day, a bad mood. But it can be difficult to refuse taking pills, since it is very difficult to switch off at night again. This is a clear dependence on the drug, which already needs to be treated.In this case, you need to consult a doctor so that he conducts a comprehensive diagnosis and helps to cope with the problem.
Taking sleeping pills on a regular basis can slow down reactions dramatically.