It is estimated that around 15% of people in large cities have insomnia. This means that in a city like São Paulo, almost 2 million people have this disorder. When we consider something broader, such as the frequency of general complaints or sleep complaints (such as difficulty sleeping or daytime sleepiness), this can go up to 70%! With so many people sleeping poorly, it's natural for many to look for something that makes them sleep better.
Among the many possible techniques for treating insomnia (such as cognitive-behavioral therapy and complementary techniques such as meditation and mindfulness), many people end up resorting to sleep medications (also known as hypnotics). There seems to be a search for a magic pill that will make us sleep well at night and wake up in a good mood the next morning.
Do these sleeping medications really work? In this blog we will discuss the uses and dangers of hypnotic medications.
Available medications for sleeping
The pharmaceutical industry has invested a lot in sleeping medications, precisely because they know that the market of people wanting to buy something that makes them get a good night's sleep is huge.
Since the 1970s, new medications have been developed specifically for the treatment of insomnia (such as benzodiazepines and zolpidem). We are currently experiencing a revolution in this area and we are entering the 4th generation of sleep-inducing medications.
These medications are specific to sleep induction and have been available for some time (which doesn't mean they don't have side effects – as we'll discuss below). Still, many people still use other medications, such as tranquilizers, antidepressants and even some antiallergics.
Often the use of these remedies is the result of self-medication. This is a big risk, because when self-medicating we do not have precise control of dose and effects. In addition, some people even resort to alcohol as an alternative to trying to sleep.
Do sleeping pills really work?
It depends on what you call sleep...
If you are simply talking about time spent in bed, the answer is "yes". Most of these medications will actually make us sleep longer. However, we have to understand that “sleeping more” is something completely different from “sleeping better”. Time is not necessarily a good indicator of good sleep quality. In fact, a greatly increased bedtime is often an indication that it is not occurring properly.
These sleeping medications act in our brain, altering the neurotransmitters that regulate our circadian cycle. With that, they end up changing a lot the architecture of our sleep.
You must remember that sleep is made up of several stages. A quality night depends on a very refined organization of the sequence and proportion of each of these stages. To make us sleep more, hypnotic remedies completely mess up the harmony between the stages of sleep.
To make us sleep more, these drugs lead to a very large increase in slow wave sleep time (also called stage N3). As this is the deepest stage, increasing it means we are almost sedated when using these medications. In contrast, REM sleep (very important for the proper functioning of our brain) is greatly diminished. This disproportion between stage N3 and REM is one of the major negative effects of sleep medications. Note that by altering the balance of these stages, sleep medications induce a completely artificial sleep.
In addition to harming the balance of these stages, many other problems can occur with the use of these medications:
Side effects of sleeping medications:
Residual drowsiness: This is the technical name for when we wake up floppy and sleepy after a night of taking a sleep medication. This happens mainly when the medication is not adjusted (either the type of medication or the dose). In that case, when we wake up we are still under the influence of the medicine that was taken the night before.
Cognitive impairments and memory problems: Remember that REM sleep is essential for our memory to function well. As these medications greatly decrease REM, they end up having a huge effect on memory.
Difficulties in Concentration and Attention Deficit: For the same reason as above, the use of these medications can make it difficult for us to concentrate and maintain attention. Because of this, people with insomnia or sleep deprived can also have learning difficulties.
Lethargy, lethargy, mental confusion, and lack of coordination: Remember we said that sleeping pills increase slow-wave sleep time? This stage is called that precisely because our brain is working as slow as possible. This is really important at night, but it's certainly not something we want during the day. Depending on the dose, people who take sleeping medications may still be on those medications even during the day. In this case, the brain works slower, causing all these effects.
Tolerance: Whenever we take a medication for continuous use, it is possible that over time it will stop working. This is called tolerance. The only way to get around tolerance is to increase the dose. However, with medications such as sleep inducers, increasing the dose too much can be quite dangerous and greatly increases the chance of side effects.
Addiction: Many of these medications can cause physical and mental addiction. In the case of mental dependence (called “conditioning”), the person no longer feels able to sleep without the medication. In the end, the remedy no longer works (as mentioned above, in the item “tolerance”), but even so, we can't leave it.
Drug Interactions: Sleep medications have many drug interactions. The main ones are with other drugs that also cause the brain to slow down. Some examples are tranquilizers, pain medications, and barbiturates. Therefore, never take one of these remedies on your own. Even if sleep medication has been prescribed by your doctor, let your doctor know about other medications you already take so that he or she can assess whether it is safe to use. Another very important drug interaction of sleeping pills is with alcohol. Never drink and take sleeping medication! The risks are great...
Risk of accidents: If you have read the package insert for one of these medications, you may have seen that it is not recommended to “drive or operate heavy machinery” after taking them. Indeed, hypnotics can cause both car and work accidents. To understand the reason for the increased risk for accidents, we just need to put together two of the side effects we've already mentioned above: residual drowsiness and attention deficit.
Falls and fractures: In elderly people who take these drugs there is an additional type of accident: the risk of falls. Falls and fractures are very dangerous in the elderly, as they greatly reduce functionality and quality of life. One must be very careful with sleeping medications in old age!
Increased snoring and worsening of apnea: Due to the relaxation of the muscles related to breathing, these conditions can worsen significantly in those who take sleeping medication.
What is the rationale behind sleeping medications?
From everything we've shown above, it's pretty clear that there are many risks and side effects associated with hypnotic medications. However, that doesn't mean they aren't useful. In fact, in some cases they can be quite important, as long as they are used correctly. To understand when sleep medications are useful, you need to understand a little bit of how to treat insomnia.
The first important thing is to understand that sleep should not be induced but should be allowed Sleep should occur naturally. Of course, this is very difficult for someone who has insomnia. Rather than inducing it, we have to seek to identify what causes insomnia and treat it. Sleeping pills never treat the cause of insomnia!
The most appropriate treatment is not one that artificially induces sleep, but one that identifies the causes of insomnia and focuses on those causes, allowing sleep to occur. In other words, the insomnia treatment should get out of the way all the obstacles that prevent you from getting quality sleep.
There are many possible causes for insomnia – as we've discussed in this blog. We usually have a precipitating factor (a trigger for insomnia symptoms) and a perpetuating factor (something that makes it chronic).
Triggers are usually some stress. Examples are: marital and family problems, financial problems, overwork, unemployment, grief, etc. Psychiatric illnesses can also trigger insomnia (such as anxiety or depression) or organic conditions (such as pain and menopause). All these conditions make anyone spend a sleepless night. Perpetuating factors are usually behaviors, habits and beliefs that cause sleep difficulties to continue, even if the initial stress has passed. In many cases, it works as if we have unlearned how to sleep. Furthermore, illnesses can also make it chronic. Examples are anxiety, depression and chronic diseases that cause pain (such as fibromyalgia and rheumatoid arthritis).
Sometimes it's not easy to identify the trigger for insomnia. Afterwards, it is also not easy to identify the behaviors that disturb sleep. Finally, it is not easy to treat the causes. These steps related to understanding and treating the causes of sleepless nights can take months. And that's exactly where sleeping pills can help.
Medicines can help us sleep, while we still can't figure out the causes of insomnia and change them. But note: sleeping pills should be a temporary treatment, while the real triggers of your insomnia are being identified.
Proper Insomnia Treatment
Because of this, insomnia medications are meant to be used for no more than 3 consecutive months. That's the time we have to discover the cause behind insomnia.
This is also why the main current treatment for insomnia, recognized by all sleep medicine societies around the world, is not drugs, but Cognitive-Behavioral Therapy for Insomnia. This therapy is done precisely with the objective of identifying causes, behaviors and beliefs related to sleep difficulties. Also, some complementary techniques (such as meditation and mindfulness) can also help. SleepUp can help you a lot in this!
Unfortunately, in practice things go very differently... People are often treated indiscriminately with sleep medications, without any commitment to looking for the causes of sleep-related problems. This only leads to the chronicity of insomnia, perpetuation of the use of medications and predisposition to all those side effects mentioned above.
What to do?
With so much information, it's only natural that we get a little lost on what to do to treat insomnia complaints. The questions below can direct us.
1. Can I take sleeping pills on my own?
Never! Above we have listed several side effects of sleep medications. When taking any medication on your own, you run a great risk of making mistakes in the dose, route of administration or choice of medication. All of this increases your risk. Remember: medications that work for other people will not necessarily work for you.
2. What is the best remedy for my insomnia?
There are many types of insomnia and different remedies can help in each case. Choosing the right medication depends on a consultation with a specialist and, sometimes, some tests.
3. Can I stop taking my medicine?
Never stop taking medication without your doctor's consent! Just as the beginning of the use of a medicine must be followed, so must the withdrawal. Stopping a drug abruptly can cause many problems. If you feel you can manage your insomnia without medication, talk to your doctor and set up a plan for it. In any case, cognitive-behavioral therapy can facilitate the process of withdrawing from sleep medications.
4. Who can I ask for help?
For drug treatment, only doctors are qualified to help you. In this case, we emphasize the importance that you seek a doctor with qualifications or training in sleep medicine (ideally certified by the Associação Brasileira de Sono). For non-pharmacological treatment, you can look for psychologists who specialize in sleep psychology. These professionals are the most qualified to apply cognitive-behavioral therapy.
5. Can I do other therapies for insomnia besides medication?
He must! In any type of insomnia, complementary treatments can help you a lot. For people who use sleep medication, these therapies can help you to get off the medication more easily. The most recognized therapy for the treatment of insomnia is Cognitive-Behavioral Therapy.
We hope you understand the role, potential benefits and risks of using sleeping pills. In any case, with or without medication, SleepUp can help you get better nights sleep. Follow our social networks and stay tuned to our releases!