Sleeping pills are widely used for the treatment of sleep-related disorders. However, it is not the first approach recommended for treating sleeping problems by many medical authorities. Non-pharmacological intervention, including cognitive behavioral therapy, patient education about sleep hygiene and relaxation techniques, are the first measures that should be considered before drugs are prescribed. Sleeping pills do have distinct benefits but should always be taken with caution. While these drugs are effective, it can also have side effects and there is the risk of addiction.
There are many different types of sleep disorders. Insomnia is a broad term for any problem involving difficulty falling asleep or staying asleep for a sufficient period for a person to feel refreshed upon waking. The number of hours that each person requires to sleep in order to feel refreshed varies among individuals. Most adults require around 7 to 8 hours per day. Some can manage on as few as 6 hours while others need 9 hours. However, it is generally agreed that sleeping less than 6 hours is insufficient while sleeping more than 9 hours is excessive.
The odd night of difficulty falling asleep or staying asleep for a sufficient period of time is not considered to be insomnia. We all have these upsets with our normal sleep patterns every now and then. Sometimes it is intentional, for example when we stay up beyond our bedtime, while at other times it can be unintentional and arise due to psychological stress and emotional states. Insomnia is generally a long term sleep problem. It can be persistent whereby it occurs almost every night, or recurrent where there are periods of sleeping difficulties followed by periods of adequate sleep.
Here are some tips to fall asleep and stay sleeping.
Why are sleeping pills used?
Sleeping pills are used for insomnia that is not responding to non-drug measures like cognitive behavioral therapy, relaxation techniques and good sleeping habits. Pills should not be the first option. Unfortunately these days sleeping pills are often prescribed even before other non-drug measures are tried. Sleeping pills are not intended to be a long term solution. Along with other treatments, sleeping pills aim to restore a normal sleep cycle so that a person can continue life without the aid of sleeping pill thereafter.
Sleeping pills typically belong to a class of drugs known as sedative hypnotics. Most induce sleep and maintain sleep. However, some sleeping pills actually reduce anxiety and treat depression since anxiety and depression can be underlying conditions in insomnia. There are a number of different types of sleeping pills. A simple way to categorize sleeping pills is that some pills help you fall asleep (induce sleep), others help you stay asleep and there pills that treat depression but also cause sedation (sedating antidepressants).
Types of Sleeping Pills
There are many different types of sleeping pills that works in different ways. Some pills are not specifically indicated for sleep problems but can assist accordingly. Others are used to treat anxiety and depression but may be effective for insomnia as well. Some painkillers (analgesics) can also help with sleeping problems although analgesics should never be prescribed for sleep-related disorders specifically.
OTC vs Prescription Drugs
There are sleeping pills that can be purchased over the counter (OTC) while others can only be acquired with a doctor’s prescription. Understandably OTC pills are usually milder, less likely to cause serious side effects and are mostly non-addictive as compared to prescription sleeping pills. Most OTC sleeping pills contain antihistamines. These are the same antihistamines that are used as allergy medication. Certain types of antihistamines can cause drowsiness which could be useful in inducing and maintaining sleep. Prescription sleeping pills are discussed in detail further below.
Tranquilizers vs Sedatives
There is some confusion about tranquilizers and sedatives. Tranquilizers are helpful for reducing anxiety. It can also induce a sense of wellbeing and usually does not cause drowsiness. Sedatives induce sleep. It causes drowsiness and an altered state of consciousness. Analgesics may also have some sedative effects, especially narcotic painkillers. Tranquilizers can be helpful for insomnia, particularly where a person has an underlying anxiety disorder. However, a sleeping pill is typically a sedative.
Categories & Duration Of Action
- Diphenhydramine – approximately 4 to 6 hours.
- Selective GABA Medicines (like zolpidem tartrate, eszopiclone, zaleplon) – approximately 6 to 8 hours
- Sleep-Wake cycle Modifiers (like ramelteon) – approximately 4 to 6 hours
- Benzodiazepines (like bromazepam, diazepam, lorazepam) – anywhere between 4 to 12 hours
- Tricyclic Antidepressants (like nortriptyline, doxepin, amitriptyline) – not conclusively known for sleeping problems
Risk of Addiction
There is a risk of addiction with all sleeping pills, although sometimes it may be a psychological dependence rather than a physical dependence. The risk of addiction of each category of sleeping pill is as follows:
- Diphenhydramine – low
- Selective GABA Medicines – low to medium
- Sleep-Wake cycle Modifiers – low
- Benzodiazepines – medium to high
- Tricyclic Antidepressants – low
A physical addiction means that a person will experience physical withdrawal symptoms and crave the drug when it is stopped. Psychological dependence is more of an issue where a person feels that they must have the drug to function properly, in this case to fall asleep and stay sleeping. It is therefore important that insomnia is also managed with psychotherapy, stress management and relaxation techniques in order for a person to cope even once the sleeping pills are stopped.
Side Effects of Sleeping Pills
The side effects of sleeping pills varies based on the type of pill in question. Some pills should not be used by people with certain conditions as it can have adverse effects. This is known as contraindications. Side effects refers to unpleasant and usually unwanted signs and symptoms that arises with using a certain drug. Almost all pharmaceutical medication have side effects. Some of these side effects may only arise with higher doses or when the drug is used for long periods of time. Others can arise with low doses and even when the drug is used once off.
Not every person will experience side effects. Some people are more susceptible than others for reasons that are not always clear. Here are some of the side effects of sleeping pills in general:
- Abdominal pain and cramping.
- Appetite changes, either wanting to eat too much or too little.
- Alterations in bowel movement – constipation or diarrhea.
- Abnormal sensations in the limbs like burning, prickling or tingling.
- Confusion and difficulty concentrating.
- Dizziness and drowsiness.
- Dry mouth, throat or eyes.
- Excessive intestinal gas leading to belching and flatulence.
- Incoordination and balance problems.
- Indigestion and heartburn.
- Muscle weakness.
- Tremors, twitching and uncontrollable shaking.
- Unusual dreams, including nightmares.