Read This Before You Start Taking Sleeping Pills
There is a wide variety of sleeping pills over the counter and through prescription. Choosing the right kind can be daunting when you're already sleep-deprived. Not sleeping well is associated with poor decision-making, so we highly recommend that you work with a healthcare professional to find one that fits your needs.
When you go to the doctor, it may be assumed that you're at your wits' end and want a strong prescription for sleep. It's tempting to grab an easy fix from the pharmacist that knocks you out. But there are so many potential drawbacks to sleeping pills that you want to make sure you consider the longer-term effects.
There are a few questions you should ask yourself first:
1. Are you allotting the appropriate amount of time to feel well-rested and have sustained energy for your day?
Some people don't actually need 7-8 hours of sleep a night. If a person doesn't fall asleep inappropriately and can function well, then they are probably getting all of the sleep they need, even if it's only 5-6 hours a night. If a person feels sleepy frequently, dozes off inappropriately (especially behind the wheel), or needs to have multiple cups of coffee to get through the day, then getting enough sleep is definitely an issue. Some adults actually need 9-10 hours of sleep to be fully refreshed. While the average is 7-8 hours for a healthy person, a portion of adults only need 5 hours, and some need 10 hours. The key is to understand your body and mind, reflecting on how you feel through the day before assuming that 8 hours is necessary or enough.
2. Are your expectations for falling asleep reasonable?
While some people can fall asleep within a few minutes of lying down, some people need 15-30 minutes to fully relax and get to sleep. 10-15 minutes to fall asleep is generally considered optimal. If you fall asleep too soon, some experts will label that as being too tired. On the other side, some experts will tell you that 30 minutes is too long and that you need to leave the bed so you break any negative insomnia associations with not getting to sleep within 30 minutes. However, everyone's slightly different. In my practice, I have found that people who stress about not being "normal" can cause unnecessary anxiety and actually create a feedback cycle that makes them even more anxious about having "a diagnosed disease" such as insomnia. This is one reason some experts recommend not having a bedside clock or checking the time. As funny as it sounds, if you deliberately stop worrying about having insomnia with more positive self-talk, that might stop the feedback cycle of anxiety-driven insomnia.
3. Do you have conditions that may be affecting your ability to sleep or contribute to a feeling of fatigue through the day?
Depression, thyroid disease, anemia, and chronic illness for example can all cause fatigue. With diabetes or metabolic disease, fluctuating blood sugars can also contribute to varying energy levels. Anxiety and maladaptive responses to stress can cause sleeplessness. In addition, many medications can also cause fatigue or sleeplessness. A few examples include allergy medications, heart medicines, blood pressure medicines, or psychiatric medicines. Occasionally side effects of some medications can actually be beneficial so you can potentially treat two conditions with one pill. For example, Trazadone (prescription) can help with depression as well as insomnia. Benedryl (OTC) can help with allergies and help you sleep at night.
This is where a medication review with your primary care provider can be especially useful. Some specialists prescribe medications without considering how it may impact every other aspect of your life. One of the roles of a PCP should be to consolidate medications. Make sure you bring your medication list as well as any over the counter or supplemental pills you may take. Many over the counter medications, herbals, and nutritional supplements have side effect profiles that can interfere with medical conditions or other pills. Just because they are not prescription doesn't mean that they are safe for everyone to use.
Primary care providers are often pressed for time and have to see a certain number of patients a day. Staying focused on sorting through one or two issues at a time can help focus the doctor visit, and you generally receive more thoughtful care than if you bring years of pent-up questions. If sleep is your main concern, focus on that, but do mention everything you can think of that may pertain to your sleep problems.
4. Prior to talking to a professional, attempt to quantify the problem so it's more specific. A health care provider should be informed of the following:
- How long had you had this problem? (Years, months, weeks?)
- Is it something that occurs in spurts? (Weeks at a time, during shift work schedule changes, or a few times a month?)
- Why did you choose now to see a healthcare professional? (Reprimanded for being late to work, lost temper, failed an exam)
- What have you tried? (Alcohol, melatonin, yoga, new pillow, sleep music)
- What other conditions or medications may be impacting sleep?
- What is your ideal goal? (getting to sleep faster, staying asleep without waking up as often, or something as natural as possible)
For relatively simple situations such as shift work or jet lag where only a few days of a medication is necessary to facilitate an adjustment, Z-medications such as Ambien may be appropriate and non-addictive. However, a recovering substance abuser should stay away from Z-medications as well as benzodiazepines such as Valium. A teenager having relationship issues may benefit from a week of melatonin. But a person with mild dementia should carefully consider any pills, even melatonin. A new breastfeeding mom should avoid NyQuil or Benedryl, but an insomniac with a cold can treat two can conditions at once with those medications.
In general, sleep medications can suppress certain stages of sleep such as deep sleep or REM sleep. Long-term use of some sleep medications can cause further cognitive impairment. It's important to have a plan to come off of sleeping pills before starting on them. Perhaps cognitive behavior therapy or talk therapy is necessary. Make sure to ask your healthcare provider if, when, and how to stop taking the medications, even if they are over the counter or "natural."
While sleeping pills can be immensely helpful for some people, there are also many serious considerations. Talking to a healthcare professional is always recommended. But if you want to try something that doesn't involve pills at all and is actually all natural, behavior changes or retraining your relationship with sleep can help nearly everyone. SleepPhones® headphones were developed by a family doctor and her husband when she struggled with insomnia after late-night patient phone calls. Listening to guided relaxation was the key to taking her mind off of work. Using SleepPhones® headphones to comfortably listen to your favorite lullabies in bed may be a key piece in combating insomnia for you too. Check it out!