Popping Sleeping Pills? Here’s What You Need To Know
- Sleeping pills are a quick-fix solution to insomnia and other sleep problems, but they also have plenty of side effects.
- Risks of prolonged sleeping pill use vary from drowsiness in the morning to the development of high blood pressure and even cancer.
- Over-the-counter sleeping pills are better at helping people fall asleep rather than keeping them asleep all night.
- Prescription sleeping pills work on the body for longer and ensure a full night’s sleep, but they might also make a person groggy during the day.
- Sleeping pills can react badly with other medications, so they should be taken after checking with a doctor.
- It’s possible, through lifestyle changes, to naturally induce good sleep and eliminate the need for sleeping pills.
The world over, millions of prescriptions are written per year for sleeping pills. These are taken by people who have insomnia and also by people who sleep fitfully and want a better quality of rest.
Users of these medicines do worry about the side effects of sleeping pills, but the need to get enough sleep overcomes such worries.
The side effects of sleeping pills are quite serious: they range from impaired daytime thinking and pill addiction to a higher risk of developing cancer and heart disease.
Natural sleep is the best sleep, and though sleeping pills may sometimes be necessary, a person who needs them too often ought to get an early diagnosis and treatment for any underlying causes of sleeplessness. The American Academy of Sleep Medicine suggests both pharmaceuticals and behavioral approaches in order to improve sleep.
Sleeping pills are known by several other names like:
- Sleep aids
- Sleep medicine
How do sleeping pills work?
There are various types of sleeping pills; each works differently.
- Some sleep aids cause drowsiness, while others silence the area of the brain that keeps you alert.
- Sleeping pills work on parts of the brain that help regulate sleep-wake pathways.
- Most sleeping pills make the sleep pathways more active. Some pills make the wake pathways less active.
- Sleeping pills generally start having an effect within 20-30 minutes of being taken, so they should be taken just before lights out.
- It is important that you get into bed after taking the sleeping tablet, as there’s a risk of feeling unsteady once the tablet starts working.
- Most sleeping pills only work for a few hours, so they’re better at helping people to fall asleep rather than stay asleep all night.
- Tablets that do help people stay asleep the whole night need to work for longer and, therefore, may cause morning drowsiness.
- Assess the effects of sleeping pills on your daytime activities before you decide to take them at night.
When do you need prescription sleeping pills?
Some sleeping pills can be purchased over the counter (OTC, or without a doctor’s prescription) and some are prescription-only pills (requiring a doctor’s prescription).
The first type is not as strong as the second type, and people who aren’t getting the sleep they need with OTC pills may want to switch to prescription pills.
However, as Mayo Clinic warns, prolonged use of prescription sleeping pills has side effects such as:
- Dizziness or lightheadedness
- Prolonged drowsiness
- Diarrhea and nausea
- Driving or eating when not fully awake
- Daytime memory and performance problems
- Severe allergic reaction
There are many factors that can determine whether to use a prescription sleeping pill or not; which pill is the best option; and how long to use it.
Here are a few times when they are right for you:
- You’re planning to use it only for a short term. If you’re struggling to sleep and need help getting back on track, a prescription pill will help you get the much-needed rest.
- You absolutely must fall asleep quickly. There are times when your schedule could go awry if you didn’t sleep at the right time. If it’s not possible naturally, a sleep aid like a sleeping pill will be right for you.
- You’re severely sleep-deprived. Severe sleep deprivation is dangerous and can have long-term effects on your overall health. At such times, sleeping pills can bring much-needed relief.
- You work shifts. Sleeping pills are useful for those who work second or third shifts and, therefore, have disrupted sleep cycles.
Risks of using sleeping pills
There are some big risks associated with taking sleeping pills that you must consider.
The longer you take sleeping pills on a regular basis, the higher the risks.
1. Higher death risk
- According to 2012 research published in the journal BMJ Open, sleeping pills are hazardous to your health and might cause death by contributing to the occurrence of cancer, heart disease, and other serious ailments. Rates of cancers were 35% higher among those who were prescribed at least 132 hypnotic doses a year, compared with those who did not take the drugs.
- A 2014 report from the European Society of Cardiology (ESC) says that sleeping pills lead to an 8-fold increase in the risk of cardiovascular events in heart failure patients.
- A 2014 University of Warwick study says, “Particularly due to their addictive potential, we need to make sure that we help patients to spend as little time on them as possible and that we consider other options, such as cognitive behavioral therapy, to help them to overcome anxiety or sleep problems.”
2. Sleeping pills impair daytime thinking
- Sleeping pills suppress the action potentials of a number of brain cells. They make us sleepy; reduce alertness and vigilance; slow down reaction times and judgment; and impair aspects of intelligence and memory.
- If the pill lingers in the blood during the day, it makes the daytime brain less active and less functional.
- Very few prescription pills leave the blood fast enough to be largely gone from the blood by morning. This means sleeping pills could impair our daytime actions, such as driving, making the commute hugely risky.
- Besides, a large percentage of people who take sleeping pills do often get up at night to visit the loo, at a time when the sleeping pill could cause a fall, especially among the elderly.
- Some people experience sleeping pill side effects, such as nausea, headaches, dizziness, drowsiness, weakness, constipation, and more.
3. Sustained use leads to accumulated blood concentrations
- The problem of daytime impairment is more severe with the longer-acting sleeping pills, because the active by-products of these drugs remain in the blood.
- When a long-acting sleeping pill is taken every night, the blood concentrations of pill chemicals accumulate day by day, increasing for up to 10-20 days, reaching much higher concentrations than after the initial dose, and daytime impairment increases after several days of use.
4. Decreased response to danger
- A 2019 study published in the journal Frontiers in Behavioral Neuroscience says that even during sleep, the brain continuously processes sensory information, waking us if it detects a threat. But the most widely prescribed class of sleeping pills, known as benzodiazepines, makes us less likely to be roused in response to sensory input.
- Benzodiazepines stimulate the widespread brain receptor GABA-A, which makes us sleepy, but also suppresses off-target brain areas, including the ‘gatekeeper’ that decides which sensory inputs to process. In a trial of one of the main class of prescription sleeping pills, half the participants slept through a fire alarm as loud as someone vacuuming next to their bed!
5. Allergic reactions
Some people have had severe allergic reactions to sleeping medication. These reactions can range from itching and hives to vomiting, skin rash, nausea, difficulty breathing and shock.
6. Problem of addiction
- Most prescription sleeping pills may be physically addicting drugs. People develop tolerance, so that a given dosage has less and less effect or stops working.
- Consequently, people who develop tolerance are prone to taking higher and higher doses of sleeping pills. This happens with long-term users of sleeping pills.
- Moreover, if the pills are stopped suddenly, they can cause physical withdrawal symptoms. These include shakiness and tremor, nervousness and anxiety, panic, hyperactivity and increased reflexes, rapid heart rate, and, in the most severe cases, epileptic seizures.
7. Risk of depression
- There’s a belief that sleeping pills might help depressed people, because chronic insomnia can cause stress and depression, and the pills keep insomnia at bay.
- But, says a 2007 report in BMC Psychiatry, sleeping pill manufacturers’-controlled trials prove that the sleeping pills themselves can cause depression. In fact, the sleeping pills seemed to double the rate of depression.
8. Link with hypertension
- According to a 2019 study published in the journal Geriatrics & Gerontology International, a study of 752 older adults with hypertension, who were also using sleeping pills on a regular basis, found increasing use of blood pressure medications over time among the test subjects.
- The findings suggest that sleeping pill use may be an indicator of a future need for greater hypertension treatment and the need to investigate underlying sleep disorders or unhealthy lifestyles that may contribute to hypertension.
9. Interaction with other medicines
The active ingredients in sleep medications can have severe interactions with other drugs, causing serious health issues.
10. Increased risk of hip fracture
- A 2017 study by researchers from Cardiff University and King’s College London, with people aged over 65 as test subjects, found that new users of these hypnotic medicines experienced nearly two-and-a-half times the fracture rate, when compared with older people not taking hypnotics.
- An estimated 53% increase in fracture risk was identified in medium-term sleeping pill users (15-30 days), as well as a 20% increased risk of hip fracture in long-term sleeping pill users (greater than 30 days).
11. Higher risk of dementia
Experts believe that when people suffer from sleep issues or insomnia, they turn to OTC drugs that contain antihistamine medicines. These are not for inducing sleep, but they do make people sleepy. These drugs fall into a class of medications known as anticholinergics, which are associated with increased risk of dementia.
12. Unusual behaviour
Some people have reported erratic behavior after taking sleep medication, including sleepwalking, shopping, and even driving, without remembering the incident afterwards. This can be dangerous.
Tips to use sleeping pills safely
- Don’t take medication without consulting a doctor. Some sleeping pills might interact with other medicines or food supplements that you take and cause adverse effects. Your doctor can determine the underlying cause of your insomnia and also help you determine what is safe for you to take.
- Have enough time to sleep. According to the Cleveland Clinic, if you’re using a sleep aid, it’s best to devote about 8 hours to sleep. Not allowing enough time to sleep can leave you feeling groggy the next day.
- Try a new sleeping pill on a night when you don’t have to work the next day. You don’t know how you’ll react to a sleeping pill when you’re taking it for the first time. It can leave you feeling sleepy the next day.
- Don’t use pills for long. You can’t use sleeping pills indefinitely. They can’t replace good sleep habits that give you healthy sleep naturally. They’re only a short-term sleep solution.
- Follow the directions carefully. Regardless of whether you’re taking prescription sleeping pills or OTC sleep aids, only take the medicine as directed. Ignoring directions can lead to adverse effects and possibly dependency on the medication.
Improve sleep without pills
Sleeping pills are not a long-term solution to sleep problems. You need to consider lifestyle modification and other approaches. They can all be more helpful than medication.
- Sleeping alone could help. If you share a bed, then approximately 50% of your sleep disturbance is caused by your partner, say sleep experts. If they’re disturbing your sleep because of snoring or fidgeting, you may want to consider separate beds or even a separate bedroom. Not sleeping together, if it works for you both, is a mature pragmatic solution to a problem and has no bearing on the strength, or otherwise, of your relationship. In fact, one-third of married couples admit to sleeping better alone!
- Get into the habit of winding down. Every night before bed, wind down by listening to music or having a relaxing bath. Delay going to bed if you feel tense.
- Manage your work/home boundaries. Don’t let work talk spill over into your entire evening and bedtime. Allow your mind to wind down and switch off.
- Organize your time. Write a to-do list before leaving work rather than at the beginning of the day. This stops you worrying about work in the evening and you’re less likely to wake up in the night worrying about tasks that need to be done.
- Become active. Regular exercise is the most effective way of reducing stress hormone levels, enabling you to sleep more deeply.
- Minimize stimulants. Caffeine has a direct impact on reducing sleep quality, and it can take up to 10 hours to remove the caffeine from your body after one mug of strong tea or coffee. If you’re having trouble sleeping, drink more water or herbal teas instead. Alcohol can also impair deep sleep quality.
- Don’t watch the clock. If you wake up at night, avoid looking at the clock and registering the time, as this will make you worry further. Lie on your back and try to consciously relax each part of your body, starting from your toes, working up to your head and your face, while breathing deeply from your diaphragm.
- Put away the trackers. Sleep trackers can create sleep problems. A study in the Journal of Clinical Sleep Medicine says that if you own a wearable fitness/sleep-tracking device, know that when it comes to sleep, the enthusiasm for the devices may overshadow what they can deliver.
Studies have found that sleep monitors can’t gauge sleep levels accurately; they can’t differentiate between light and deep sleep. These devices can also reinforce poor sleep habits, such as spending too long in bed in order to increase the number of sleep hours.
- Declutter your sleep space. Don’t bring work into your bedroom, and keep your laptop and phone out of your bed. The ideal temperature is slightly cool, so keep windows slightly open or have the AC running in the room.
- Don’t stress over sleep. The more pressure you put on yourself to sleep, the less likely you are to actually fall asleep. The night before a big work event or getting up early to catch a plane, it’s often helpful to replace the word “sleep” with “rest”. Tell yourself, “It doesn’t matter if I don’t sleep tonight, I’m going to use the time to rest.”
- Eat enough protein during the day. High-protein foods include meats, fish, beans and lentils, seeds and nuts (choose unsalted and raw rather than roasted). Protein foods provide the amino acid, tryptophan; this converts to melatonin hormone, which is needed for good sleep.
Avoid large meals and too much hard-to-digest food for 3-4 hours before going to bed. Hard-to-digest foods include red meat, cheese, and fried foods. Stay away from sugary foods such as chocolate, sweets, cakes, sugary drinks before bedtime. The sugar rush from these foods can keep you awake and destabilize your blood sugar levels by triggering an excessive release of insulin hormone. This can hamper sleep.
When you achieve a good night’s sleep, you feel energized during the day, find it easier to concentrate, cope with stress better, and are more likely to experience long-term good health.
Sleeping pills are not a long-term solution. Getting good sleep naturally would involve making changes in your diet, increasing movement, practicing better sleep hygiene, and choosing therapies such as yoga, meditation, aromatherapy etc.
Remember, when you sleep soundly for 7-8 hours at a time, you have the lowest risk of disease and the highest possibility of optimal wellness.
- Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open, 2012;2:e000850 DOI: 10.1136/bmjopen-2012-000850
- S. Weich, H. L. Pearce, P. Croft, S. Singh, I. Crome, J. Bashford, M. Frisher. Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study. BMJ, 2014; 348 (mar19 5): g1996 DOI: 10.1136/bmj.g1996
- Kripke, D. F., Greater incidence of depression with hypnotics than with placebo, BMC Psychiatry 7:42. 2007