I would recommend against ever using any of the following sleeping pills except for a special night or two, now and then when sleep may be especially difficult and important. Short-term sleeping pill use is usually safe in itself, but it is impossible to predict with any certainty who will slide down the slippery slope into long-term chronic use.
And all too often, the sleeping pills are used in conjunction with other psychiatric and pain meds that in combination can be dangerous, even deadly. But addiction is a very big risk – too often the person gets hooked on the pills and comes to rely on them long-term. Sleeping pills are usually benign when taken as they should be prescribed – only occasionally, in response to a special, non-recurring situation.
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A change in expectations and the few simple steps of good sleep hygiene are usually enough to get people through the night:. Fortunay, most people don’t need sleeping pills to deal with sleeping problems.
Sometimes, I fall right back to sleep. Sometimes, I can’t sleep for hours and instead do boring, but hopefully useful, stuff like writing this blog at 2 a.m. Instead, I make the best of being able to get my work done nocturnally, without the usual interruptions – and I make up for it with a really treasured mid-day nap. If I didn’t know better, I might be seduced into using sleeping pills to get through the night. For at least the past decade, I have awakened about every ninety minutes almost every night – usually in the midst of a vivid and often entertaining dream. I have vast personal experience living with, and adapting to, strange sleep patterns.
The Centers for Disease Control reports that 9 million Americans used a prescription sleeping pill at least once in the past month. Add this to the many millions of other people who buy over-the-counter remedies that often have a similarly poor risk/benefit ratio. Currently, many doctors are remarkably casual and careless in their prescription of sleeping pills.
Better to accept and find ways to live comfortably with imperfect sleep than to take on the much greater risks of sleeping pills.
It is important to identify and treat the disorder and the insomnia will usually improve as a consequence. Most psychiatric and all substance disorders can cause or be associated with insomnia. For some people, insomnia is not a stand-alone problem, but rather a symptom of psychiatric and/or a substance abuse disorder and treating the insomnia in isolation won’t work.
It is important to accept sleep diversity-we are so very heterogeneous in our sleep patterns that defining normal sleep is difficult. Seeking sleep uniformity or perfection causes more harm than good. For many of us, especially as we age, trouble sleeping is an inevitable part of life.
A night-owl has great difficulty keeping early bird hours, but might do just fine in a job that allows a later start. Sleeping pills are so massively over-utilized in part because there is no gold standard of normal sleep. And people tend to be poor judges of how much they sleep – usually underestimating the number of hours compared to sleep lab testing results. Perfect sleep is an elusive goal that becomes dangerous if sleeping pills become the attempted means. Individual variation is great in the number of hours needed, the timing of falling asleep and waking up, and how refreshed people feel in the morning. An early bird starling, like myself, has trouble staying awake for prime-time TV, but can alertly write a blog at 4 a.m.
Myself A Loved One (Adult) A Loved One (Minor) A Patient or Client Other.
I must admit to occasionally using them myself, especially on long plane trips. The biggest risk is drowsiness on awakening – not a great idea if you have to drive to work the next day. If you must use a sleeping pill for that rare occasion, I would recommend an over-the-counter antihistamine (e.g., Benadryl).
-Allen Frances. Just like every other bodily function, sleep architecture degenerates biologically with age – and sleep is also challenged by all those middle of the night trips to the bathroom.
This is a really bad idea – sleeping pills are often addictive, cause many dangerous side effects, and have a terrible risk/benefit ratio. Many people worry a lot about sleepless nights and try to avoid them with sleeping pills.
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These all have troubling side effects. These would include antipsychotics (e.g., Seroquel) and antidepressants (e.g., doxepin, trazodone). Drug companies have been clever in rebranding as sleep meds those psychiatric meds that cause so much sedation as a severe side effect that they are not useful as psych meds.
But I would go even further than the American College and suggest that sleeping meds should rarely, if ever, be prescribed to anyone who is not already taking them. They are much more likely to harm than to help, often causing big long-term trouble for just a very small short-term gain. It is a huge step forward for America’s leading doctors to recommend talk therapy, rather than the more routine practice of prescribing pills.
Bright screens reset our brains to keep us awake. And older folks, like myself, usually discover, sooner or later, that they have permanently lost the gift of sleeping like a baby. Preventing insomnia is much wiser than treating it with sleeping pills, but prevention is difficult because there are so many different causes, and many are difficult or impossible to avoid. Substance use is a common culprit – obvious in heavy users; subtle, but still important, even for typical coffee or wine drinkers or smokers. Pain, medical illness, obesity, and breathing problems can make drifting off to sleep, and/or staying asleep, a nightly challenge. Shift work, jet-setting, and partying all screw up natural chronobiological rhythms. Real and/or imagined 24/7 job responsibilities keep people burning candles at both ends. Sleep is extremely sensitive to stress and worry.
And the rate jumps to an incredible 7% in people over 80 years of age. Rates of prescription sleeping pills are creeping up – now 4% of all adults regularly use sleeping pills; 5% of women, 3% of men.
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The most common side effects of sleeping pills are:
If you are already using sleep meds regularly, definiy don’t stop them suddenly or on your own. If you are not already taking sleeping pills, the best bet is probably not to start. -Allen Frances Sleep meds are problematic and to be avoided, particularly in the elderly where they promote falls, confusion, accidents, and memory loss. If you are now occasionally taking sleep meds, make sure you don’t go from occasional to regular. Withdrawal can be very disturbing and even dangerous. If you decide to try to get off, do it very slowly and only under close medical supervision. Better to accept and find ways to live comfortably with imperfect sleep than to take on the much greater risks of sleeping pills.
Sleep hygiene is the preferred first-line approach – self administered, practical, commonsensical, and usually works wonders. Help from a professional via brief CBT, relaxation exercises, yoga, and/or meditation is a very valuable and convenient second-line approach to be recommended whenever sleep hygiene is not enough.
Recently, the American College of Physicians published guidelines for chronic insomnia. Surprisingly, they recommend Cognitive Behavioral Therapy, not meds, as the first-line of treatment. Sleeping pills are to be used only when CBT has failed – only short term – and only after the patient has been briefed on all the many problems they frequently cause.
The elderly are especially vulnerable to harm from sleeping pills because they have less cognitive reserve, more prone to falls, and less able to clear and metabolize the active ingredients of sleeping pills. Whenever I see a confused old person, my first question is whether he is taking a sleeping pill. It is paradoxical and extremely stupid that the very people most likely to be harmed by sleeping pills are also the most likely to get a prescription for them.Sleeping pills