We've all had sleepless nights - lying in bed, staring at the ceiling, wondering why our brains keep chugging along even as the clock strikes four in the morning. The answer is probably different for everyone: too much caffeine, an onslaught of anxiety, bodily discomfort. But a fidgety night here and there is normal.
However, over the past few decades, either our insomnia has increased dramatically or our tolerance for it has precipitously dropped - because we're taking more sleeping pills than ever before. Between 2002 and 2008, there was a 70% increase in prescriptions from an industry that brings in over $2 billion a year. So what's going on: Who isn't sleeping well and who is turning to pills? As it turns out, the answer in both cases is more women than men.
Who Uses Them?
According to a nationwide survey administered between 2005 and 2010, five percent of women versus three percent of men reported using pills to assist them in sleeping.
Several studies have demonstrated that women's reliance on sleeping pills increases as they age. In a 2007 study by the National Sleep Foundation, over ten thousand women between 18 and 64 were polled on their sleeping habits. The findings state that women report more sleep problems as they get older and postmenopausal women (41%) were the most likely to utilize sleep aids multiple times a week. But why is it that women tend to use sleep medication more than men? At this point, all we have is speculation.
Carl Bazil, neurology professor and the director of the Division of Epilepsy and Sleep at Columbia University Medical Center, says, "Women are known to have higher rates of insomnia. That likely has several causes: more depression, more willingness to admit to a sleeping problem, perhaps different outlets for stress release." He also suggested that "women may also be more aware of the effects of sleep loss, whereas men may insist that they don't really need much sleep."
Daniel Kripke, emeritus professor of psychiatry at U.C. San Diego, also cites depression as a factor, but further ascribes women's sleep issues to our biological landscape. "Pregnancy, childbirth, the menstrual cycle, and menopause are part of the reason, but there may be other biological and psychological reasons which are not well understood," he said.
What Are The Different Types Of Sleeping Pills?
Zolpidem, better known as Ambien, currently holds the superlative for most popular sleep aid in the U.S., with over 40 million prescriptions in 2011 alone. It is a potent drug: earlier this year, the FDA announced that zolpidem remains in the body longer than previously thought, especially in the case of women, whose metabolisms process the drug slower. The agency subsequently issued a call for physicians to prescribe the lowest-effective dose in order to minimize day-after impairment.
Ambien belongs to a class of drugs known as hypnotics, which is cleaved into two subcategories: benzodiazepines and non-benzodiazepines. The former includes anti-anxiety meds, like Klonopin and Valium, which can be habit-forming. Non-benzodiazepines, like Ambien and Lunesta, operate within the brain similarly to Klonopin and related fare, but are widely considered to be safer. Beyond the realm of prescription drugs are over-the-counter and herbal alternatives. Regarding the former, most options include an antihistamine. Diphenhydramine is a popular choice, found in the U.S. under the brand name Benadryl. While it seems like these would be inherently less troublesome than, say, a habit-forming benzodiazepine, we still know very little about the risks of using medications like Benadryl for sleeping purposes. What we do know is as follows: that tolerance for antihistamines builds up quickly so they rapidly become less effective and that it is indeed possible to fatally poison yourself with this type of drug.
Herbal alternatives seem safer by virtue of being natural, but that's not necessarily true. Some herbal supplements have been known to cause organ troubles (see the FDA's 2002 advisory about kava), as well as adverse interactions with other drugs. Within this category, melatonin and valerian root are commonly used combat mild insomnia, but they may not be as effective in more dramatic cases. For melatonin, data suggests that around five percent of the U.S. population may be utilizing it. But as the FDA still classifies it as a dietary supplement and not a drug, information on its usage and side effects remains somewhat anecdotal. However, a 2013 report in PLOS ONE suggests that it is in fact useful in improving sleep quality.
What Are The Risks?
Although the newer nonbenzodiazepine pills are theoretically less perilous, the truth, as with most drugs, is more complicated.
Common side effects for sleep aids can include daytime drowsiness, shallow breathing, and confusion. In the case of zolpidem, hallucinations are possible. Less common, but nevertheless problematic, are parasomnias, a set of sleeping disorders involving bizarre behaviors over which the patient has no control: sleepwalking, unconscious binge eating, having sex while unawake. Kripke estimates that these complications affect around 1% of users. If the pills are chased with alcohol, which some people do out of desperation or depression, the results can be even more treacherous, sometimes fatal. According to sleep expert Matthew Edlund, "combining depressants like booze and sleeping pills is a kind of personal roulette."
But the most critical threat may be to our future selves. According to Jerry Siegel, professor of psychiatry and biobehavioral sciences at UCLA's Center for Sleep Research, "Evidence continues to accumulate indicating that whereas insomnia does not shorten lifespan if left untreated, the use of sleeping pills does shorten lifespan in both men and women."
Kripke helped demonstrate this in a 2012 study published by the journal, BMJ Open. After reviewing the electronic medical records of over 40,000 patients, Kripke and his colleagues were able to identify a correlation between hypnotic sedatives and an almost five times greater risk of death. Furthermore, they discovered that patients who took at least 132 doses a year had a 35% higher rate of new cancers than those who abstained.
What's It Like To Use Sleeping Pills?
In an effort to better understand what it's like to be an actual user of sleeping pills, we spoke with a woman who considers herself dependent on the meds. She kindly shared her experiences with us, but wished to remain anonymous.
My correspondent has been suffering from insomnia since high school. "It's just completely debilitating, you know? I can't function like that," she says. For the last three-and-a-half years, she has been using the anti-depressant-cum-sleeping-pill trazodone. A few days before our conversation, her doctor had upped her prescription and added Klonopin in response to a recent bout of sleeplessness. Even though she says she took the pill at a normal hour, she reported still feeling fuzzy during our chat, which was shortly before noon.
"I'm drinking coffee," she said. "I'm still so groggy and out of it."
She admitted that she had been able to sleep better since the prescription increase, but her daytime experiences anecdotally confirmed the warnings of diminished functioning.
"Which is better?" she asked. "Do I just suck it up on three hours of sleep and then go to work? Or do I take this trazodone and Klonopin and then know I'm going to be knocked out, but it's going to be hell to get myself out of bed?"
According to the experts, the answer should be neither. "I can't stress enough how important sleep habits are," Bazil insisted. "Regular exercise, yoga, meditation, or other relaxation techniques can help your body deal with stress and help convince your brain that it's okay to sleep. In the long run, that's what helps."
Whatever side you come down on, it is clear sleeping pills are still shrouded in a network of misunderstanding and mystery. The only way to move forward is to reexamine both our pill consumption and our relationship to sleep in order to better understand the roles and risks of each. Sleeping pills aren't unanimously detrimental, but in our overly medicated culture, it wouldn't be a terrible idea to get a better grasp on the substances we put in our bodies.
By Lex Berko
