Natural Sleep & The Dark Side of Sleeping Medications
As a health advocate for your clients, the following might be of interest to you.
It is common practice to quote that we spend a 1/3 of our lives sleeping. But do we? In the US between 6-10% of people are taking sleeping medications.
I have been researching and writing a Medications section for my upcoming The Sleep Mastery Course. The findings have caused me to reconsider this global statement about sleeping and to share my findings with you.
Basically, I am a 'good' sleeper, even though I am writing this at 3am and became interested in sleeping not due a lack of it, rather because clients would present to the clinic with spinal pain after a night of sleeping. But you can't interact with the world of sleeping without bumping into insomnia and quality of sleep.
Poor quality sleep (insomnia) is strongly associated;
- chronic pain and prediction of pain onset
- poorer physical performance and recovery/rehabilitation
- poorer memory and concentration
- high blood pressure, CVA and heart attacks
- poorer mood and emotional stability
and the list goes on. There is not a system or function which the human body undertakes that is not adversely impacted by a lack of sleep. If you think about our clients, if they aren't getting sufficient sleep how can our treatments be effective?
Sleep has to become antecedent in the minds of all clinicians and our subjective questions need to reflect this. But I digress, back to medications.
If I can't sleep I just take a pill. All's good?
In Australia, the most common forms of sleeping tablets are benzodiazepines and non-benzodiazepine hypnotic medications, for example temazepam (Temaze, Normison), zopiclone (Imovane) and zolpidem (Stilnox). The older styles (e.g., temazepam) target the majority of gamma aminobutyric acid (GABA) receptors, while newer ones like zolpidem, are considered more selective in the targeting of GABA receptors. These are basically hypnotic medications, that is, they knock you out.
Given the key function of sleep seems to be to provide an environment to facilitate the repair and recovery of our brain and body, one would think the goal of provided medications would also be to improve the quality and continuity of sleep. However, both single doses of temazepam (1,2)and zolpidem (2) have been shown to reduce the duration of slow wave cycles in the brain. These slow wave cycles are associated with consolidation of memory and learning. When zolpidem was given to young cats, not only was the development of their memory connections less, but there was a 50% reduction (i.e., unwiring) in neural cortical connections compared to controls. It would seem then that sleeping tablets do not replicate the nurturing and restorative environment of natural sleep.
Side Effects of Sleeping Pills
So, being 'knocked out' isn't providing the natural benefits of sleep but are there any side effects to consider?
- Think reduced memory (as noted above) and reduced psychomotor performance. Not ideal for anyone wanting to improve athletic performance or avoid nocturnal falls.
- Plus sleeping tablets have a diminishing effect, so require increasing dosage over time and they are addictive.
- Then when you decide to stop taking sleeping pills you will rebound insomnia, in which your sleep is worse and can lead to people restarting the use of sleeping pills. If you decide to stop sleeping pills, discuss with your GP first.
- Oh, and then there is the small matter of death...
A large US study of 10529 individuals taking mostly zolpidem or temazepam, were compared with 23676 well matched controls over a 2.5 year period. A does related relationship was found to exist between frequency of medication use and death. For individuals taking >132 doses/year they were 5.32 (95% CI 4.50 to 6.30) times more likely to die during the period of study. What was eye opening, was those that just dabbled in sleep medications (< 18 doses/year) were still 3.60 (95% CI 2.92 to 4.44) times more likely to die.
As a result of taking sleeping tablets, what are people actually dying of?
One reason is an increased rate of infection. Sleep is one of the most powerful boosters of our immune system and not achieving a natural sleep seems to go hand in hand with an increased susceptibility to infections. Given older folk are the greatest consumers of sleeping medications it is making them more susceptible to infection - something to consider in our current COVID status. Another cause is cancer. Kripke's prior mentioned study, demonstrated that takers of sleeping medications were 30 - 40% more likely to develop cancer during the 2.5 year period of study, than those not taking medications. The number one reason motor vehicle drivers in the US die in road accidents is due to falling asleep at the wheel. Most likely due to the lack of restorative sleep and the prevailing hangover/mental fog sensation the next day, associated with the use of sleeping medications.
What can you do to advocate for your client's health and improved natural sleep?
I am in the process of writing an online sleep course, for which you can express an early interest (and earn your self a 40% discount) by adding your name here and you can read about my sleep posture research here.
1. Dijk, D., et al., Effects of seganserin, a 5-HT2 antagonist, and temazepam on human sleep stages and EEG power spectra. European Journal of Pharmacology, 1989. 171(2-3): p. 207-218.
2. Arbon, E., M. Knurowska, and D. Dijk, Randomised clinical trial of the effects of prolonged-release melatonin, temazepam and zolpidem on slow-wave activity during sleep in healthy people. Journal of Psychopharmacology, 2015. 29(7): p. 764-776.
3. Seibt, J., et al., The non-benzodiazepine hypnotic Zolpidem impairs sleep-dependent cortical plasticity. Sleep, 2008. 31(10): p. 1381-1391.