The dangers of sleeping pills and how to avoid them

Using sleeping pills can also be deadly. According to a 2010 study, up to half a million “excess deaths” in the United States were due to the use of sleeping pills called sedative-hypnotics.

People with prescriptions for these sleeping pills, which include zolpidem and temazepam, had more than four times more likely to die from accidents and health problems resulting from use compared to those who did not use such drugs, according to the study. Even people who took less than two sleeping pills a month were three times more likely to die than those who didn’t.
If you are using or considering using a prescription or over-the-counter sleeping pill, what do you need to know to do so safely? We asked Dr. Jing Wang, assistant professor of pulmonary, critical care, and sleep medicine at the Icahn School of Medicine at Mount Sinai in New York.

This conversation has been lightly edited for clarity.

CNN: When someone comes to you with insomnia or another sleep disorder, begging for help falling asleep, do you give them a sleeping pill first for immediate relief?

Dr. Jing Wang: Absolutely not. We try very, very hard not to do that. When someone presents with insomnia, we take a very comprehensive medical and sleep history. It is very important that the person shares their personal information so that we can identify the source of the insomnia. Is it behavioral, or is it related to medication or a medical condition?

I will ask them: “What is your schedule during the day? What do you do in the evening?” to try to find their physical and emotional stressors. Is this person constantly on a screen at work and at home?

Next, we look at how this person prepares for bed: “Do you have routines? Do you have a regular bedtime?” Often insomnia is perpetuated by what we do in response to the inability to sleep. People get very creative in ways that may not be helpful: they scroll through the phone, check email or respond to work messages, or sleep with the TV on. Both of these expose you to blue light, which sends a signal to the brain to wake up. Every now and then you’ll hear people say I get up and work out, which is definitely not what you want to do!

CNN: When might a sleeping pill be advised?

Wang: Our frontline approach is to introduce patients to a form of cognitive behavioral therapy called CBTI, which is specifically for insomnia. It educates patients on healthy sleep behavior like regular bedtime and wake times, keeping screens and blue lights out of the bedroom, doing relaxing things before bed, etc. It’s about the associations our brain makes with our sleep environment and how our behaviors or activities affect it.

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If we have someone who is clearly suffering from a very acute onset of insomnia and there is an identifiable factor or change in their life, then we could have a discussion about a short term trial of a sleeping pill for a few weeks or a month or more, and only with regular check-ups.

And we set clear expectations around short-term use, because we don’t want to just prescribe a sleeping pill and have the person take it for the next 30 years. We want to get to the root of the problem in a healthier way by fixing what triggers insomnia.

CNN: Why isn’t long-term use of a sleeping pill healthy?

Consult a physician before taking any type of sleep aid.

Wang: It depends, because people have different responses and can be sensitive in different ways. Some of these sleeping pills can be addictive, so the person feels like they can’t sleep without them. They can be dangerous if mixed with alcohol or certain painkillers. Some cause daytime sleepiness and may interfere with driving and other motor activities.

Sedative sleeping pills have been associated with hallucinations and dissociative behaviors. People drove cars, cooked food, sleepwalked and made phone calls, all without any memory when they woke up. After waking up, people may experience drowsiness and confusion, like a hangover effect.

CNN: Let’s talk about over-the-counter drugs. Is it a problem?

Wang: All medicine is a double-edged sword: it has its uses, but it always has side effects.

One of the strongest pieces of advice I always give patients is to tell them to really try to avoid over-the-counter sleeping pills. They can have unexpected side effects, like making you hyperactive instead of sleepy. There is potential for interaction with prescription sedatives, which patients may also take. And there’s always potential for abuse or overuse because they think, “Oh, it’s over the counter so it’s safe.”

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Take melatonin. Some people have reported taking 30 or even 60 milligrams of melatonin and it could be dangerous; we do not know yet. It’s not really regulated, so substances other than melatonin can be mixed into the pill or tablet. You might get headaches, one of the known side effects of melatonin. Or you could take it at the wrong time and interfere with your circadian rhythm.

Antihistamines, for example, create a dry mouth, dizziness and a sort of hangover feeling the next day. They may also have anticholinergic effects, such as urinary retention, blurred vision, constipation, and nausea. In some studies, chronic and regular use of these agents has been associated with an increased risk of dementia.

Finally, using over-the-counter sleep aids can potentially delay seeing their sleep problems as a concern and seeking care: “There’s no reason for me to see the sleep doctor or that I talk to my doctor about my sleep issues. I can just continue using an over-the-counter agent.”


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