"If you can’t sleep, then get up and do something instead of lying there worrying. It’s the worry that gets you, not the lack of sleep."
Dale Carnegie

Being awake when everyone else is sleeping is one of the worst things in the universe. Anyone who has had insomnia can tell you that a sleeping pill that works feels like a miracle.

For decades, the benefits and risks associated with sleeping pills have been a controversial topic.

Important Fact You Need to Know

Sufficient sleep is as important as food and air. Most people would agree that there’s nothing better than a good night’s sleep. However, sufficient does not equal the more the better. And insomnia is not synonymous with short sleep.

It is not true that you need eight hours a night of sleep. In fact, people who sleep between 6 and 7 hours live the longest and sleeping more than 8 hours is associated with progressively increasing risk of death1-2. Six hours of sleep is adequate for most people. According to the following study, even those with as little as 5 hours sleep lived longer than participants with 8 hours or more per night.

A six-year study of more than one million adults ages 30 to 102 has shown that people who get only 6 to 7 hours a night have a lower death rate. Individuals who sleep 8 hours or more, or less than 4 hours a night, were shown to have a significantly increased death rate compared to those whose who averaged 6 to 7 hours. The best survival rates were found among those who slept 7 hours per night. The study showed that a group sleeping 8 hours were 12 percent more likely to die within the six-year period than those sleeping 7 hours, other factors being equal.

What are the benefits of sleeping pills?

Quite helpful as a short-term aid

Sleeping pills are effective temporary, short-term solution to sleep problems. They are appropriate for transient or acute insomnia, when sleep is temporarily disturbed by a stressful event, a medical problem, or jet lag. Sleeping pills can break the cycle of insomnia, minimize the fear of insomnia and anxiety.

You can try sleeping pills for a short time while you work on the problems that are causing your insomnia.

They work fast

Sleeping pills may quickly relieve the symptoms of insomnia. They generally produce almost immediate effects, and thus may be prescribed for short-term, intermittent, “as-needed” use.

Easy way out

Sleeping pills offer an easy way to switch off the mind and sleep.

However, every person who sees sleeping pills as an easy solution should seriously think about the impact they may have on health and choose drugs to combat insomnia only after trying all other alternatives.

What are the dangers?

People taking sleeping pills have higher mortality rates

Did you know that people who take sleeping pills have higher mortality rates than people who do not take them? This means that people who take sleeping pills die sooner than people who do not use sleeping pills.

Studies and tests carried out with several million participants, have determined that there is a 25% increased mortality rate among people who take a sleeping pill nightly, and a 10%-15% mortality if sleeping pills are taken occasionally1. However, the exact role that sleeping pills play in this high mortality rate is not clear.

The only way to be certain if the sleeping pills are directly causing the risk would be to randomly offer volunteers either sleeping pills or placebo pills for long-term trials. However, such studies would be quite hard to realize, and the ethical concerns would have to be overcome.

Possible carcinogenic effects

Dr. Daniel Kripke, a senior psychiatrist at the Scripps Clinic Sleep Center in San Diego, California has found evidence that taking sleeping pills regularly can increase the risk of skin cancer4.

He did the analysis and has just published the findings in the Journal of Sleep Research. The paper looked only at the newest sleeping pill, ramelteon (Rozerem), zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata). The study suggests that taking sleeping pills increases the risk of cancer, especially skin cancer. Even though there is no obvious reason how or why a sleeping pill could cause cancer, it is nonetheless possible.

Impaired daytime functioning, thinking and alertness

The advertising gives the impression that sleeping pills help you to work better, think better, or function better the next day. People may hope that sleeping pills will improve their long-term health. But the effects are just the opposite of what people hope.

Sleeping pills reduce brain cell activity during the day, affecting daytime thinking, alertness, short-term memory as well as causing a hangover-like effect.

This is because most of the prescription hypnotics, when taken at bedtime, will remain in the blood with at least half strength when morning comes.

Researchers have found that people who drive after taking sleeping pills are at a much greater risk of having a car accident5. Falls are much more common among elderly people who take hypnotics6.

Parasomnias: bizarre sleep behaviors

Although these events are rare, they may be extremly dangerous.

Parasomnias are behaviors and actions over which you have no control. 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.

Do Not treat the causes of insomnia

They don’t treat the causes of insomnia, which means that insomnia often returns upon discontinuation of the medication.

Sleeping pills do little or nothing to improve chronic insomnia.

Mask the problems

Sleeping pills can mask the real causes of poor sleep, such as depression, heart trouble, or asthma and delay treatment of these disorders.

Of particular concern is the presence of sleep apnea, a condition where the sleeper stops breathing for brief intervals during the night. Sleep apnea results in less restful sleep, and possibly insomnia. However, a hasty prescription for sleeping pills may only serve to hide the problem, rather than offering a solution. Moreover, studies indicate that sleeping pills may actually make sleep apnea worse7.

Lose effectiveness when used on a regular basis

Over time your body will build up tolerance to sleep medication. Tolerance is the body adapting to the presence of a drug. When tolerance to a drug increases, more of the drug is necessary to achieve the same effect. Users of tranquillizers and sleeping pills soon develop tolerance to the calming effects of these drugs. In contrast, there is usually no tolerance to the harmful effects: more drug produces more harm. When tolerance builds, it is dangerous to continue using the drug.

‘Rebound’ insomnia

Another drawback of sleeping pills is ‘rebound’ insomnia – the inability to fall asleep, or stay asleep after discontinuing the medication. When you begin to take sleep medication you are no longer relying on your natural ability to sleep.

Dependency

People can become physically or psychologically dependent upon sleeping pills. People feel that they are unable to cope without the drug, and the physical symptoms of withdrawal support their belief.

Withdrawal symptoms

Stopping the drug abruptly may cause withdrawal symptoms. Many doctors continue to renew prescriptions without offering adequate support and information on withdrawal.

Interactions

Sleeping pills, antidepressants and alcohol all act as central nervous system depressants. In combination, they act to slow things down even more, and the lethal consequence can be that a person simply stops breathing.

What is the key?

Don’t take sleeping pills if you can avoid them, even the newer ones. Try to change the areas of your life that contribute to problems with sleep.

References

• The Dark Side of Sleeping Pills by Daniel F. Kripke, M.D.
• 1. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry. 2002 Feb;59(2):131-6.
• 2. Patel SR, Ayas NT, Malhotra MR, White DP, Schernhammer ES, Speizer FE, Stampfer MJ, Hu FB. A prospective study of sleep duration and mortality risk in women. Sleep. 2004 May 1;27(3):440-4.
• 3. Burazeri G, Gofin J, Kark JD. Over 8 hours of sleep–marker of increased mortality in Mediterranean population: follow-up population study. Coat Med J. 2003 Apr;44(2):193-8.
• 4. Kripke DF. Possibility that certain hypnotics might cause cancer in skin. J Sleep Res. 2008 Sep;17(3):245-50.
• 5. Gustavsen I, Bramness JG, Skurtveit S, Engeland A, Neutel I, Mørland J.Road traffic accident risk related to prescriptions of the hypnotics zopiclone, zolpidem, flunitrazepam and nitrazepam. Sleep Med. 2008 Dec;9(8):818-22. Epub 2008 Jan 28. PubMed
• 6. Fonad E, Wahlin TB, Winblad B, Emami A, Sandmark H. Falls and fall risk among nursing home residents. J Clin Nurs. 2008 Jan;17(1):126-34. PubMed
• 7. Bradshaw DA, Ruff GA, Murphy DP. An oral hypnotic medication does not improve continuous positive airway pressure compliance in men with obstructive sleep apnea. Chest. 2006 Nov;130(5):1369-76. PubMed