By Diane Sparacino, Staff Writer
As a culture, Americans have an issue with sleep. To start with, we work hard and lead stressful lives. We multi-task and juggle like crazy as we raise children, struggle to send them to college and save for our own retirement. It seems there are never enough hours in the day. Catching up on shut-eye is often a luxury, easily sacrificed for “just one more” episode of Housewives or the chance to scan your neglected in-box for unread messages.
Enter the magical sleeping pill – promising a blissful night of undisturbed sleep filled with raindrops on roses and butterflies aplenty. Finally, time to say farewell to the futile act of sheep-counting; good riddance to hours of frustrating tossing and turning. It seemed too good to be true – now researchers are finding that perhaps it is.
For myriad reasons, there’s an ever-growing need for sleep. According to the National Institutes of Health’s National Center on Sleep Disorders Research (NCSDR), sleeping disorders affect about 70 million Americans, 60% of whom are dealing with a chronic sleeping disorder. The costs to society – from lost productivity and accidents to significant health issues related to sleep deprivation – are staggering and in the tens of billions (NCSDR, n.d.) Those seeking help in the form of a pill have also grown. In 2010, approximately 6% to 10% of adults in this country took a hypnotic drug (i.e. zolpidem, temazepam), to help them sleep (Kripke D., et al, 2012).
The problem isn’t new. We’ve been able to trace sleeping potions and remedies back to the times of the Ancient Greeks and Egyptians, when opiates extracted from the poppy flower were favored as a cure. Throughout the ages, humans continued to puzzle over sleeping disorders. They used various herbs, barks and seeds during ancient times. In the Middle Ages, the English dispensed “drowsy syrups,” while apothecaries stocked a wine-soaked sponge mixed with herbs called “spongia somnifera.” In the early 1800s, chemist Frederick Setumer found a way to synthesize opium. By 1832, chloral hydrate had become a player; the powerful chemical acted as a depressant on the central nervous system and was fast-acting. In 1857, bromides were discovered. Several bromide salts were included in the class of sleeping drugs. Like their predecessor, chloral hydrate, the bromides worked on the central nervous system. First used to treat epileptics, their sedative quality was soon discovered. They remained popular sleep aids into the early twentieth century (Encyclopedia.com, 2002).
In the early 1900s, Phenobarbital, from the barbiturate class of drugs, was introduced. By the 1920s and 30s, a slew of new barbiturate-based pharmaceutical remedies came into play including Amytal, Pentothal and Seconal. While effective in producing sleep, barbiturates were not the panacea chemists had hoped. They were addictive, had a variety of negative side effects and could cause death when mixed with alcohol. Benzodiazepine came along in the 1960s, but shared a lot of the side effects with its predecessor. In 1970, the FDA began to regulate the ingredients in OTC medications including sleeping aids (Encyclopedia.com, 2002).
Fast forward to present day -- when sleeping pills are all over TV, the Internet and in magazine ads; they are readily available by prescription and freely dispensed. Today’s prescription sleeping pills fall into three major categories: They help you fall asleep, stay asleep, or are a combination of the two (Mayo, 2011). Common side effects of sleeping pills/aids can include: “Headache, muscle aches, constipation, dry mouth, daytime sleepiness, trouble concentrating, dizziness, unsteadiness, and rebound insomnia,” depending on the dosage, the drug and how long it remains in one’s system (Robinson, 2012). Still other sleeping pills, known as “sedative-hypnotic drug products” which include benzodiazepines and non-benzodiazepines, can cause serious side effects like sleep-walking and sleep-driving, where the person has no memory of the event. As such, experts warn that sleep aids should be used sparingly and only as needed, (i.e. when traveling or after a medical procedure), to avoid developing a dependency or tolerance – both issues that can come from long-term use (Robinson, 2012).
Which takes us to the recent study published in February 2012, led by Dr. Daniel F. Kripke of Scripps Clinic in La Jolla, Calif. Kripke and his colleagues looked at the association between hypnotic sleep aids and mortality, and what they found has set off warning bells for many. "Rough order-of-magnitude estimates ... suggest that in 2010, hypnotics may have been associated with 320,000 to 507,000 excess deaths in the U.S. alone," they wrote (Kripke D., et al, 2012). In addition, those who used hypnotics the most showed an increased risk of cancer; as high as a 35% increase in those taking high doses (Bankhead, 2012).
Kripke and his team followed 34,205 subjects for an average of 2.5 years (10,529 patients taking hypnotic prescriptions and 23,676 in a control group). In addition to increased mortality, key findings included: “Patients receiving prescriptions for zolpidem, temazepam and other hypnotics suffered over four times the mortality as the matched hypnotic-free control patients.” Perhaps most shocking is this statement: “Even patients prescribed fewer than 18 hypnotic doses per year experienced increased mortality, with greater mortality associated with greater dosage prescribed” (Kripke D., et al, 2012).
For years healthcare professionals have told their patients about alternative sleep remedies. After first checking with their doctor that there is no underlying health issue at the root of the problem, establishing a healthy pre-bedtime routine, relaxation therapy and staying active seem to be among the most popular pieces of advice in helping to manage chronic insomnia (Mayo, 2011). In fact, a Stanford University of Medicine study reported that patients who participated in regular, “moderately-intense aerobic exercise for 30 to 40 minutes four times a week, slept almost an hour longer than those who did no exercise at all” (NIH in Robinson, 2012).
As the research continues to probe the safety concerns related to sleeping pills, it’s a good idea to continue to explore the alternative methods for avoiding sleep deprivation and the health issues that come with it.
RN.com is pleased to offer a new course especially for nurses and healthcare professionals: Stress Relief for the Healthcare Professional, provides up-to-date information about the stress response, prevention and management, including proven techniques to help relieve stress. For more information on sleeping disorders, therapies and pharmaceuticals, try these links: Your Guide to Sleep (an NIH publication), HelpGuide.org and Mayo Clinic.
Bankhead, C. (2012). MedPageToday.com. Sleep Disorders. Sleeping Pill Death Toll May Top 500,000. Retrieved from: http://www.medpagetoday.com/PrimaryCare/SleepDisorders/31391
Encyclopedia.com. (2002). Sleeping Pill: How Products Are Made. Retrieved from http://www.encyclopedia.com/doc/1G2-2897100080.html
Kripke D., Langer R., Kline L. (2012). Hypnotics' association with mortality or cancer: a matched cohort study. BMJ Open 2012;2:e000850. Retrieved from: http://bmjopen.bmj.com/content/2/1/e000850
Mayo Clinic.com. (2011). Health Information. Insomnia. Prescription sleeping pills: What's right for you? Retrieved from: http://www.mayoclinic.com/health/sleeping-pills/SL00010
The National Center on Sleep Disorders Research [NCSDR]. (n.d.). Retrieved from: http://www.nhlbi.nih.gov/about/ncsdr/about/about.htm
Robinson, L., Kemp, G., M.A. (2012). Helpguide.org. Sleeping Pills, Natural Sleep Aids & Medications. Retrieved from: http://helpguide.org/life/sleep_aids_medication_insomnia_treatment.htm
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