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5 reasons to think twice before taking sleeping pills

"Sleep is the golden chain that ties health and our bodies together," wrote Thomas Dekker. Yet for too many people in the modern world, that chain is stretched to - and often well past - breaking point.

People who suffer from depression, arthritis, asthma, back problems, diabetes, obesity and just plain stress have an increased likelihood of experiencing insomnia, as do older, divorced/separated people with less education, poor health and/or low income. Women report more difficulties than men with falling asleep, waking during the night, and waking too early in the morning.

With sleep problems so prevalent, it's no wonder so many people resort to using medications to try to get to sleep: 4% of all Australians, and a whopping 37% of those aged over 65, are taking sleeping pills at any given time.

But what are the risks of using common prescription sleep medications?

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#1. Sleeping pills - including benzodiazepines (such as temazepam and diazepam, sold as Restoril,  Normison, Xanax, Librium and Valium), non-benzodiazepines (such as zolpidem - sold as Ambien and Stilnox), barbiturates and sedative antihistamines - increase the risk of death, even when taken fairly irregularly.

Research published in February 2012 (1) revealed that people who took sleeping pills were, on average, 4.6 times more likely to die during a 2.5 year period compared to those not taking such drugs. There was a 3.6 times higher risk of dying in those taking just 0.4-18 pills a year; 4.4 times higher risk in those taking 18-132 pills a year, and 5.3 times higher risk in those using 132 pills a year, compared to non-users.

The risk is even higher if you're overweight: obese participants who took 18 or fewer pills annually had an 8.1 times higher risk of death compared to obese people who did not take the medications, while those on 132 or more annually had a 9.3 times higher mortality rate.

To answer the criticism that people in poor health are both more likely to experience poor health and more likely to die than those in poor health (which would mean that there was an association, but not a causal relationship, between sleeping pill prescription and death), the researchers separated out those in poor health - and the results still held. In their words, "Control of selective prescription of hypnotics for patients in poor health did not explain the observed excess mortality."

This is not an isolated finding; of the 24 studies published as at January 2012 on mortality risks of sleeping pills, 21 studies showed that people taking sleeping pills died sooner, while one found no overall increased mortality risk but did find sleeping pill usage was associated with excess cancer mortality (2).

Possible causes of excess mortality among sleeping pill users are "hangover" effects (reduced brain cell activity during the day, which makes people sleepy, less alert, confused, and weak during the day, in turn increasing the risk of falls and accidents), worsening of breathing pauses in sleep apnoea (which increases blood pressure, heart attacks, heart failure and stroke), an increased risk of suicide due to exacerbation of depression (see point # 5 below), accidental overdose, and cancer (see next point) (2).

#2. Frequent use of sleeping pills is associated with an increased risk of cancer. The same study (1) found that those in the highest bracket of sleeping pill use had a 35% higher risk of developing cancer. Once again, the researchers used statistical adjustment to factor out the effect of pre-existing disease, and found that "death and cancer hazards associated with hypnotic drugs were not attributable to pre-existing disease." 

#3. Sleeping pills are addictive, and the withdrawal symptoms include insomnia!
While sleeping pills almost always help you go to sleep the first couple of times you take them, tolerance (where the dose you were taking no longer works to get you off to sleep) develops quite rapidly. It only takes between 3-14 days of continued use to become tolerant to a benzodiazepine sleeping tablet, while tolerance may take somewhat longer to develop to other types of medication.

After several weeks of use, sleeping pills work no better than a placebo - but when you stop taking them, you are likely to suffer rebound insomnia, a drug withdrawal-induced insomnia which is often worse than the insomnia you originally took the drug for in the first place (3).

Another common withdrawal symptom is anxiety. Since anxiety makes it hard to get to sleep, it is a cruel irony that the drug you take to 'turn their mind off' so you can sleep, makes it even harder to turn your mind off when you stop taking it! One of the primary reasons people become hooked on sleeping pills is because they experience such anxiety and poor sleep if they try to stop. But if they stayed off the drug for a few days, they might sleep just as well without it (4)! 

#4. Using sleeping pills impairs daytime performance. People often resort to sleeping pills because they are afraid that their inability to sleep at night will impair their concentration, memory, mood and other aspects of performance the following day. They figure it MUST be better to take the pill and at least get some sleep. But the overwhelming majority of controlled studies show that even when a person sleeps somewhat longer after taking a sleeping pill, their performance is either worse on the following day, or they function no better in their daily life than they would if they had just missed a few hours of sleep. Ability to process information, make mental calculations, remember important facts, and most worryingly, drive a car safely, are all impaired by sleeping pill use (5).

Daytime impairment is obviously more severe with the longer-acting drugs including diazepam (Valium) and chlordiazepoxide (Librium), which accumulate in the bloodstream over the course of 10-20 days, reaching much higher concentrations than after the initial dose. But even drugs with a short half-life, such as Ambien, may still be in the bloodstream by morning, at doses capable of impairing performance, if taken in the middle of the night. Furthermore, there is some evidence that even after these short-acting drugs are fully eliminated, they may still impair performance of daily tasks (6).

#5. Sleeping pills increase the risk of depression, which is a major cause of insomnia. Since at least 80% of depressed people experience insomnia, it might be reasonable to think that insomnia medications may be helpful in treating depression. However, an analysis of data of clinical trials on sedative hypnotic drugs found that they more than doubled the risk of developing depression compared to placebo pills (7). What this means is that sleeping pills are more likely to cause depression than to help it.

One of the unfortunate consequences of severe depression is an increased risk of suicide, and long-term users of sleeping pills have a markedly raised suicide risk (8).So what do you do if insomnia is ruining your life, but you don't want to take these risky medications? An integrated sleep program comprising good sleep hygiene, optimal nutrition, and EFT (Emotional Freedom Techniques) will restore your body's in-built ability to get a good night's sleep.

References here.

RobynRobyn Chuter is a university-qualified naturopath, with a Bachelor of Health Science (and the Dean's Medal for Outstanding Academic Achievement) from the University of New England, and a Diploma of Naturopathy from the Australasian College of Natural Therapies. Robyn runs the website Empower Total Health; and she has a naturopathic practice in Sydney, Australia where she specialises in chronic, medically 'incurable' health problems such as IBS, CFS, migraine, high blood pressure and type 2 diabetes.

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