Why sleeping pills aren’t the solution

For many people, sleeping pills are the go-to medication for sleepless nights. Many insomniacs will readily attest to the same.

However, several people still wonder whether or not sleeping pills are beneficial. Misconceptions about the use of sleeping pills are widespread too.

Sleeping pills and health

According to the US Centers for Disease Control and Prevention, a survey conducted between 2005 and 2010 showed that the percentage of adults on prescription sleep medication increased with education and age.

But doctors have repeatedly favored other treatments since depending on sleep pills can eventually lead to an addiction.

“If a person is physically, mentally and emotionally healthy, they will definitely get good sleep,” says Dr Ayush Gupta, senior consultant, sleep medicine, Fortis Flt Lt Rajan Dhall Hospital, Delhi. “Various stressors in life, illnesses or other factors lead to either difficulty in sleeping or lack of sleep altogether. These may be temporary or become permanent triggers in life. However, taking medications for these conditions is never recommended as the primary mode of treatment.”

Sleeping pills are never the permanent solution but are just a temporary fix — and must be taken with caution. In many cases, long-term use of sleeping medications can worsen matters.

Prolonged sleeping trouble could be a symptom of severe underlying disorders. This is why people are advised to seek help from a doctor.

When sleeping pills don’t work

Experts say people should not worry if the prescribed sleeping medications are not working for them – this can happen sometimes. It does not necessarily mean they need a higher dosage.

Dr Shivani Swami, consultant, pulmonology and sleep medicine, Narayana Multi-Specialty Hospital, Jaipur, gives some tips to help people sleep better without sleeping pills:

• Regular bedtime and out-of-bedtime
• Avoid naps during the afternoon; if you must have a nap, it should be limited to not more than 45 minutes
• Late afternoons or early evenings are a bad time to nap — this is likely to interfere with night-time sleep
• Do not spend excessive time in bed while awake
• Alcohol, tea, coffee and smoking are bound to interfere with sleep quality, and are best avoided, especially in the evenings
• Avoid strenuous exercises and challenging mental activities during the evenings
• Regular exercise is beneficial when performed three to five hours before bedtime
• Those who find themselves unable to put the day to an end in their minds, can try writing down their concerns and plans for the next day before going to bed
• The bedroom should be quiet, and the temperature must be adjusted as per individual preference
• Those who tend to keep looking at the time should not keep any watch or clock in the bedroom since it may affect their sleep
• Lighting in the bedroom should be optimised as per personal preference
• Light reading or meditation may be helpful before going to bed
• Consuming excessive amounts of liquids before going to bed must be avoided
• Never go to bed hungry or thirsty
• People should ask their doctor if they have been prescribed any wakefulness-promoting medications. If yes, they should ask for these to be substituted or, if possible, if these can be had in the afternoon or early evening instead.

Side effects of sleeping pills

A 2017 study by Pennsylvania State University suggested that the risk of falling (physical imbalance) is higher in seniors who using prescription sleeping pills. Such falls often lead to brain injuries and fractured bones.

Sleep medications can broadly be divided into three categories: benzodiazepine, nonbenzodiazepine and OTC (over the counter) drugs. The common side effects include:

• Drowsiness
• Light-headedness
• Headache
• Weight gain
• Nausea

Dependence and tolerance are two interrelated side effects of sleeping medications.

Over time, the body becomes habituated to such pills, and a higher dosage is required to feel the impact. Some people are said to build ‘tolerance’ towards these medicines. In time, they cannot stop having the medicines and experience worse or no sleep without the drugs. This hyper-dependency is the onset of addiction.

“These sleeping pills are associated with side effects, including dependence and tolerance,” Dr Ayush Gupta says. “A person can even become addicted to the use of medicine. Hence, it’s best to avoid sleeping pills. Primary insomnia, which is not associated with any other medical disorder, is very rare. Insomnia is usually associated with other disorders like depression and anxiety, and other psychiatric disorders, which, when treated effectively, automatically lead to the resolution of insomnia. One can easily avoid using sleeping pills. Self-medication of sleeping pills is dangerous.”

Dr Swami also stresses that the use of sleeping pills will lead to tolerance and dependence.

Alternative to sleeping pills

“The primary treatment for insomnia is behavioural change and following good sleep hygiene,” Dr Gupta says.

“When we talk of sleep hygiene, one should create an environment conducive to good sleep. The bedroom should not be used for multi-purpose work such as office work, computer use, mobile use and watching movies. The room should be kept strictly for sleeping. Also, an individual should learn that they should not chase their sleep; sleep is a natural phenomenon that will come sooner than later to them. Remember, sleep is actually a reflection of one’s state of mind.”