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Sleeping pill epidemic

Updated on June 28, 2015

Sleeping pill use

How often do you take sleeping pills?

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Introduction

Insomnia is a condition affecting twenty-two percent of Americans regularly, and forty-eight percent occasionally, according to the National Sleep Foundation. The costs of sleep deprivation are numerous. For example, " Drowsy drivers account for about 100,000 accidents every year in the United States, according to the U.S. National Traffic Safety Administration."(Six Wise, 2009) Some patients, following several sleepless nights, reach in their medicine cabinets for a sleeping aid, or rush to their doctors' offices for a prescription. Like all medications, sleeping pills have their place. They should not, however, be taken lightly. While patients may benefit from short-term use of sleeping aids, most of these are not approved for long-term use, due to the risk of addiction, as well as many other health effects.

Addiction/Tolerance

One of the negative effects of sleeping pills is the risk of addiction and/or tolerance. A patient, desperate for a good night's sleep, reaches for a medication. Within minutes, he or she drifts off and wakes up finally feeling refreshed. The pill works so well that the following night or the next time the patient cannot get to sleep, he or she resorts to the same treatment, which that individual now believes to be the solution to his or her insomnia. This happens over the course of a week or two. Eventually, the body adapts to the sleeping aid and the pill is no longer as effective as it used to be. Even worse, the patient is now unable to fall asleep without what was once meant to be used just this one night. This is especially true for older classes of sleeping aids, such as barbiturates and benzodiazepines. Even newer medications (see table below for classes of sleeping pills) are not without the risk of these phenomena occurring, so no one is insured against the potential of tolerance and/or addiction to sleeping aids .

Sleeping aids and pregnancy

Pregnant women should not take sleeping pills. Even though insomnia is one of the many discomforts of pregnancy, not a single sleeping aid is classified as Category A (proven safe for the unborn fetus in well-controlled human studies). Lunesta, Ambien, Sonata, Trazodone, Amitryptiline, and Rozerem are considered Category C (see table below for categories) , while Benadryl is Category B . Xanax, Kloponin, Valium, Ativan,Luminal, Seconal, and Amytal are Category D . Halcion is Category X. As these categories show, no sleeping pill has been proven safe to the developing fetus, and pregnant women should only use sleeping aids if all other options have been attempted and exhausted first.

FDA pregnancy categories

Category
Meaning
 
A
Proven to be safe for the baby
 
B
No risk shown in animal studies
 
C
Risk shown in animal studies
 
D
Evidence of risk in humans
 
X
Risks outweigh benefits
 
N
Not classified by the FDA
 
http://www.drugs.com/pregnancy-categories.html

Other health conditions and sleeping pills

In addition to pregnancy, there are a number of other health conditions that may preclude or limit the use of certain sleeping aids. For example, benzodiazepines should not be taken by patients with a history of liver or kidney disease, depression, history of drug or alcohol abuse, by the elderly, or by individuals with respiratory problems, such as asthma, emphysema, COPD, and bronchitis. Non-benzodiazepines, though safer than their benzodiazepine predecessors, are contraindicated for patients with many similar health conditions, as well as very high or very low blood pressure. Over-the-counter medications are additionally not suitable for patients with heart conditions, and seizures, among others. Antidepressants should not be taken if one has recently experienced a heart attack or suffers from bleeding disorders. Rozerem is contraindicated for patients with severe liver conditions. Barbiturates should be avoided by the elderly, especially if they are being treated for mental health conditions. Thus, patients with a substantial number of health conditions should not take sleeping pills or take them with caution.


Types of sleeping pills

(click column header to sort results)
Type  
   
Examples  
Pros  
Cons  
Sedative hypnotics
Benzodiazepines
Xanax, Kloponin, Valium, Ativan, Halcion
effective for short-term insomnia
dependency, tolerance, lighter sleep, hangover effect, birth defects
 
Non-benzodiazepines
Ambien, Ambien CR, Sonata, Lunesta
little or no hangover effect, lower risk of dependency, lesser effect on sleep stages
amnesia, hallucinations, parasomnia
Over the counter
 
Benadryl, Unisom
good for short-term or acute insomnia, good first medication to try
tolerance, hangover effect, not for people with glaucoma, asthma, and other conditions
Antidepressants
 
Trazodone, Amitryptiline, Doxepine,
help with pain, non-addictive, few side effects
can cause blurred vision, hangover, dry mouth, GI symptoms, urine retention
Sleep-wake cycle modifiers
 
Rozerem
non-habit forming, can be used long-term, in older adults, with sleep apnea and COPD
not for severe COPD, liver impairment, sleep apnea, may worsen depression
Barbiturates
 
Luminal, Seconal, Amytal
can relieve anxiety and tension if used in low doses, can control seizures
tolerance, addiction, dangerous in higher doses
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Sleeping pills and premature death

The most serious side effect of sleeping pills is premature death. According to a study by Kripke, Langer, and Kline, even patients who took fewer than eighteen sleeping pills per year were 3.6 times more likely to die during the observation period than patients who did not take any sleeping pills. The risk only increased for patients who took more sleeping aids, to 4.43 for those who ingested 18-132 per year and 5.32 for those who used more than 132 per year. This study demonstrates that even occasional use of sleeping pills increases the risk of mortality and this should be considered carefully before the physician prescribes another batch of Ambien or Lunesta.






Conclusion

In summation, insomnia afflicts many patients, nearly half of the population experiencing it occasionally. While insomnia is a cause of misery, health problems, and can be downright risky, sleeping pills are not the answer in the long run, They are meant to be used for the treatment of acute or short-term insomnia, with very few being approved for long-term use. The risks of sleeping pills are numerous and not all of them are covered in this hub. The possibility of addiction/tolerance, lack of safety for pregnant women and their unborn children, multiple health conditions precluding or limiting the use of sleeping pills, as well as premature death, are only a few of them. Does this mean one should never resort to sleeping aids? Not at all. However, all other options must be attempted first, and sleeping pills should only be prescribed when the benefits clearly outweigh the risks to the patients. These medications should not be the first answer when faced with sleepless nights.

References


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Peters M.D, Brandon. "Doxylamine Not Recommended as Long-Term Insomnia Treatment Found in Unisom and Nyquil, Doxylamine Causes Sleepiness as a Side Effect" 6 November 2012. About.com Guide. Retrieved 8 May 2013. <http://sleepdisorders.about.com/od/sleepdisorderstreatment/a/Doxylamine.htm>

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"The 6 Most Common Causes of Automobile Crashes". 2009. Six Wise. Retrieved 28 June 2015. <http://www.sixwise.com/newsletters/05/07/20/the-6-most-common-causes-of-automobile-crashes.htm>

"Trazodone Oral" WebMD. Retrieved 12 May 201u3. <http://www.webmd.com/drugs/mono-89-TRAZODONE+-+ORAL.aspx?drugid=11188&drugname=trazodone+oral&pagenumber=5>

"Unisom Oral" 2013. WebMD. Retrieved 12 May 2013. <http://www.webmd.com/drugs/drug-10525-Unisom+Oral.aspx?drugid=10525&drugname=Unisom+Oral&source=1>

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