If I can’t sleep, should I take a sleeping pill?
Have you ever taken a sleeping pill or considered taking them to help you sleep? You are not alone. Large population studies in the US, UK and Australia have found that between 4-10% of adults have taken sleeping pills at some point to help them sleep.
Whether or not to take sleep medication will depend on your individual circumstances and the nature of your sleep problem. Sleeping pills can be helpful if you are highly distressed or worried about your sleep and sleep deprivation is causing significant problems in your life. However, there are a number of side effects and downsides to taking medication, so you will need to weigh up the pros and cons before choosing this option.
Sleep medication is only recommended for short term use and should not be taken for more than four weeks. So if you have chronic insomnia (more than three months) and sleeping pills haven't helped you overcome the problem, its time to look at a more effective long-term solution. The thing is, medication doesn’t address the underlying causes of insomnia, therefore, sleep problems can resurface once the medication is stopped.
What are the different sleeping medications and how do they work?
If you decide to use a sleeping pill, the type of medication you need will depend on the sleep problem you have.
If the difficulty is falling asleep at the start of the night, a doctor may suggest a “fast-acting” sleep medication, such as a benzodiazepine. These sleep-inducing medications take effect within half an hour of being taken and can last for 3-6 hours.
If you wake too often during the night, and can’t get back to sleep, then a doctor might recommend a “slow-acting” medication such as suvorexant, that will have benefits throughout the night. These longer-lasting medications can help you to stay asleep longer, however, they carry the risk of causing drowsiness in the morning until the effects of the medication wear off.
What are the most common sleep medications?
Benzodiazapine (e.g. temazepam: Temaze, Normison), and bendodiazapine-like medications (e.g. zopiclone: Imovane; and zolpidem: Stilnox).
The most common type of fast-acting sleeping pills prescribed are benzodiazepines. They work by relaxing the body and reducing muscle tension, causing drowsiness, and enhancing the sleep pathways in the brain. Unfortunately, benzodiazepines can be addictive and lead to dependence.
There are also a range of side effects that might outweigh the benefits including: daytime drowsiness, changes in appetite and bowel function/constipation, dizziness, mouth dryness, headache, and nausea.
Also, the effects of the drug begin to wear off over time, and insomnia is a common withdrawal symptom. For these reasons, “benzos” should only be used in the short term and no more than four weeks.
Suvorexant (e.g. Belsomra).
Another type of mediation is one that reduces the wakefulness pathways in the brain. It can be helpful for people who wake up in the second half of the night and find it difficult to mentally switch off. Suvorexant has also been approved in Australia for use longer than three months.
Suvorexant can also have side effects such as daytime drowsiness, increase of parasomnias (sleep walking etc), changes in appetite and bowel function/constipation, dizziness, mouth dryness, headache, and nausea.
Melatonin (e.g. Circadin).
Melatonin is a natural hormone produced in the brain to assist with regulating our sleep/wake cycle (circadian rhythm). A synthetic version can be useful to assist the brain to prepare the body for sleep.
Anti-histamines (e.g., promethazine: Phenergan; doxylamine: Restavit).
While these medications were designed to treat allergies, they have a sedating effect causing drowsiness. While some people use anti-histamines to help them sleep, there are several problems with this type of medication including morning drowsiness, a high tolerance risk, meaning they are less effective after using them for a few weeks. Furthermore, new medical research has linked long term use to an increased risk of dementia.
Antidepressants (e.g., amitriptaine: Endep; mirtazapine: Avanza) and antipsychotics (e.g. quetiapine: Seroquel; olanzapine: Zyprexa).
While newer, modern antidepressants don’t tend to assist with sleep, the older tricyclic antidepressants do cause mild sedation, so occasionally they are prescribed for sleep problems. Many anti-psychotic medications also cause sedation and drowsiness which can aid sleep, but there are many side effects, including weight gain, morning drowsiness, or an increase in risk of diabetes and cardiovascular disease.
If not sleeping pills, what else will help me sleep better?
The most effective long-term solution to insomnia is a non-drug treatment called cognitive behaviour therapy (CBT), and newer versions also include mindfulness training (called mindfulness based therapy for insomnia (MBT-I)
These psychological and behavioural treatment address the underlying causes of your sleep problems, and they teach you practical skills to improve your sleep.
A key benefit of CBT-I and MBT-I treatments is that they address underlying causes of your insomnia, so you can prevent sleep problems occurring again in the future.
In summary, while sleeping tablets might help your sleep the short term, the best long term solution is to undertake a treatment program of CBT-I or MBT-I. Online CBTi/MBTi courses are offered by A Mindful Way. Learn more here.
N.B. If you have been taking sleeping tablets and are having difficulties reducing or stopping your use, it is important to seek support from your GP or prescribing doctor. Changing dosages and/or stopping these medications without the support of a doctor can lead to additional difficulties, such as withdrawal symptoms, or rebound insomnia.
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Looking for more information?
You can find more information about insomnia here. And you can learn more about the influence of thinking on sleep in the related articles When the mind won’t stop thinking, just sit back and watch and Are you stuck with insomnia, chronic fatigue or anxiety?