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The Connection Between Drugs, Alcohol and Sleep Health

Not getting enough sleep can affect both your physical and mental health, depending on how little sleep you’re getting.

There are several different types of sleep issues. Some of the most common are:

  • This is a condition where you are unable to initiate or maintain sleep, or when you wake up hours early and cannot go back to sleep
  • Narcolepsy. This accounts for excessive daytime sleepiness sometimes described as “sleep attacks” that may occur in unusual circumstances.
  • Restless Legs Syndrome (RLS). This is described as a “creeping” sensation and is associated with aches and pains throughout the legs that causes difficulty initiating sleep.
  • Sleep Apnea. This is a condition where someone makes periodic gasping or “snorting” noises that momentarily interrupts their sleep.

According to the Centers for Disease Control and Prevention, these are only four out of more than 80 different types of sleeping disorders, each of which can disrupt your sleeping patterns.

If you have trouble falling and/or staying asleep, or if your sleep patterns are irregular, make an appointment with a doctor. A doctor determines what type of treatment you need and will decide if you need to take sleeping pills or not.

During the appointment, your doctor will ask you a series of questions pertaining to your sleep. They may order tests to see if there are any underlying conditions that may be causing difficulty sleeping.

Underlying issues may include medical conditions, medication use, psychiatric disorders, or substance abuse.

In certain cases, behavior changes learned through cognitive behavioral therapy are generally the best treatment for persistent insomnia. Trying to sleep on a schedule, exercising regularly and avoiding caffeine are a few things that can help.

However, depending on what type of sleeping disorder you suffer from, you may also be prescribed sleeping pills or other types of sleeping aid.

SLEEP AID MEDICATIONS:

Common medications, including Zolpidem (or Ambien), Eszopiclone (Lunesta) and Zaleplon (Sonata), are nBZRAs prescribed to help you fall asleep.

Benzodiazepines such as Alprazolam (Xanax) and Diazepam (Valium) are prescribed for anxiety disorders but can also help with insomnia.

BZDs act on the central nervous system by enhancing the effect of the gamma-aminobutyric acid (GABA) neurotransmitter. GABA is an inhibitory neurotransmitter that suppresses central nervous system activity.

While BZDs non-selectively bind to all GABA receptors, the nBZRAs bind specifically to GABA-BZ receptors, inducing a sense of calm.

General practitioners prefer to prescribe nBZRAs for sleep aids because they are attributed with greater benefits and fewer side effects than BZDs.

Still, evidence suggests nBZRAs may be associated with similar harmful side effects.

Over the years, BZD prescriptions have decreased, while prescriptions for nBZRAs have skyrocketed. Like other drugs, a dependence on these sleep medications can occur, creating an addiction that can be harmful to the body and hard to manage.

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SELF-TREATMENT:

Insomnia predisposes someone to psychiatric disorders, aggravates medical conditions, decreases the quality of life and increases the risk of drug and alcohol abuse. More than 50% of people with depression, psychosomatic disorders, anxiety disorders, neuroses, dementia and schizophrenia have complaints of insomnia.

Instead of going to a doctor to get their insomnia treated, some people choose self-treatment. Over-the-counter (OTC) sleep aids and different types of supplements and/or alcohol are common among insomniacs.

The reason is because these self-treatments are easier to access, cheaper and are shown to be safe to use.

Most people will continue to self-treat without seeing a doctor until their OTC aids no longer work.

OVER-THE-COUNTER SLEEP AIDS:

Antihistamines consist of a broad class of pharmacologic agents that include the first-generation, central acting histamine (H)i receptor antagonists.

The primary action of this drug class is to block the effects of histamine, which reduces congestion, sneezing, coughing, and allergy symptoms.

Centrally, these drugs block histamine receptors. Histamine is one of the major alerting central neurotransmitters. Due to the sedative action of antihistamines, they are widely used as non-prescription sleep aids.

Some of the most popular over-the-counter sleeping aids are ZZZQuil, Tylenol PM, Nytol and Sominex. These drugs, and almost all other OTC drugs, contain the active ingredient diphenhydramine, a type of antihistamine that causes drowsiness.

Other sleep aids, such as Unisom SleepTabs and Kirkland Nighttime Sleep Aid, list their active ingredient as doxylamine succinate. Doxylamine succinate is also a type of antihistamine and shares the same mechanism of action as diphenhydramine and the potential for tolerance to doxylamine’s sedative effects exists.

NATURAL SUPPLEMENTS AND HERBS:

Supplements and herbs are viewed as the “natural” option for sleep aid, providing a safe alternative to prescription drugs and OTC products.

The manufacturers of these products are held responsible for the strength and safety of their products, as  there are currently no FDA regulations on standards for the manufacturing of dietary supplements.

Because there are no set regulations, these manufacturers are forbidden from marketing their products as treatments or cures for any medical disorders, including insomnia.

Different types of supplements and herbs include:

  • This is a flowering plant species Valeriana officinalis most often used in the treatment of anxiety and insomnia..
  • John’s Wort. This is a medicinal herb used for a variety of ailments like depression, anxiety and fatigue.
  • This is an extract of the Polynesian plant Piper methysticum. Supplements that contain kava are marketed to alleviate menopausal symptoms, anxiety and insomnia.
  • This is a hormone released by the pineal gland that regulates sleep-wake cycles. It is used as a supplement used to combat jet lag and sleep disturbances.
  • This is an amino acid that comes from food. Once absorbed in your body, it can be converted to serotonin (a neurotransmitter that’s associated with sleep) and melatonin.

ALCOHOL:

Alcohol is commonly used and has a complex interaction with sleep processes.

Alcohol reduces sleep latency time. This is the time it takes to fall asleep after the lights have been turned off. However, it also affects sleep architecture, or the second half of your night of sleep.

This can result in poor memory consolidation and fragmented sleep. Unfortunately, tolerance to alcohol’s sedative effect can develop over two to three days with increased alcohol consumption needed to promote sleep.

While there are no studies to show how any of the popular supplements and herbs might  cause issues with dependency, prescribed medications, OTC drugs and alcohol can all lead to a dependency on some level.

This dependency can eventually lead to an addiction or substance abuse, both of which can be detrimental to your sleep efficiency and overall health.

SLEEP AID ABUSE:

Most doctors prescribe sleep aids when they deem it absolutely necessary and only for short periods of time. One of the main reasons for this is because the continued use of these drugs can lead to an addiction and/or substance abuse.

Abuse is defined as someone taking more sleep medication than prescribed or for longer than its intended use. Though the drugs themselves aren’t actually addictive, an addiction can still occur because of the body’s dependency on them.

The present criteria for substance dependence include:

  • Tolerance.
  • Escalation of dosage.
  • Continued use despite efforts to stop or knowledge of adverse effects.
  • Other behavioral features.
  • Withdrawal syndrome.

Exposing the body to one thing for too long can be detrimental in a lot of cases.

When using sleep aid for an extended period of time, especially longer than the doctor prescribes or is recommended to you, a tolerance to the medication can occur.

Once a tolerance is built against prescribed medication, people end up escalating their dosage without their doctor’s knowledge to get the results they were receiving before their tolerance for it rose.

When OTC drugs no longer work the way they once did, people are more likely to increase the dosage of OTC drugs they’re using and continue taking the drugs past the FDA recommended two-week period.

With alcohol, there is a higher chance that someone will drink more than their usual amount before the tolerance built to fall asleep.

It is not uncommon to self-prescribe higher doses of any type of sleep aid to reach the desired level of effects these drugs may give, even though the risks may be higher with the more aid consumed.

Different sleep aids have different side effects, such as alcohol dependency being identified as a risk factor for excessive daytime sleepiness or cases of transient psychosis, including schizophrenia, followed by the usage of zolpidem (Ambien).

Continuing to use these sleep aids improperly turns into abuse and, depending on what someone puts in their body, the abuse can be paralyzing to the mind or body or even fatal.

A case study done on a 27-year-old law student who increased his Ambien dosages from 10 mg to 500 mg resulted in his tolerance being so high that his insomnia remained untreated as though he wasn’t taking the medication at all.

Over time, the male became aggressive and isolated, dropping out of college and, within two months, being hospitalized in a psychiatric ward. Three years later, he was diagnosed with schizophrenia.

The effects of zolpidem on the central nervous system include headache, dizziness, nightmares, confusion and dizziness, drowsiness, sensory disorders in all senses, delirium, and complex behaviors, such as sleepwalking and sleep eating.

Man with insomnia and an alarm clock on his nightstand

Doctors prescribe certain dosages of sleep aids for a reason, and that reason is to protect their patient from immediate or future harm to their physical and mental health.

Sleep aids, whether prescribed or over-the-counter, are supposed to be used only as a short-term solution because the effects they have can alter your life long-term and in a negative way.

Fortunately, there is always a road that can lead back to sobriety from these addictions and sleep aid abuse.

SLEEP AID ABUSE TREATMENT:

The first step to treating sleep aid abuse would be to visit a doctor.

Doctors can take a look into your mental and physical health to determine what the next best steps are, which usually result in being checked into a program at a rehab facility or treatment center.

These programs offer the best environments in which to rid the body of substances because you’ll be monitored, coached and encouraged to get your body back to the way it was before the abuse and addiction took place.

In a treatment program, it is very possible that you may participate in a number of psychological assessments. These assessments are used to track your progress or decline and to see what does and doesn’t work for you.

Being in rehab forces you to change your lifestyle and get your mental and physical health levels back to normal, which can help with the insomnia you were dealing with in the first place.

If you suspect that you or a loved one suffer from sleep aid substance abuse or addiction or even from a sleeping disorder, know that there is always someone available to help you through your issues and get you on the road to recovery.

There is no time to waste when it comes to substance abuse, especially when it can be detrimental to your health and well-being.

Sources

Ashton, H., 2005. The diagnosis and management of benzodiazepine dependence. Current Opinion in Psychiatry, Issue 18, pp. 249-255 from

Centers for Disease Control and Prevention, 2014. Key Sleep Disorders. [Online] [Accessed 2 April 2019] from

Christopher N. Kaufmann, P. M. et al., 2005. Trends in prescribing of sedative-hypnotic medications in the United States: 1993–2010. Pharmacoepidemiol Drug Saf, pp. 637-645 from

Christopher N. Kaufmann, P. M., Adam P. Spira, P., Colin A. Depp, P. & Ramin Mojtabai, M. P. M., 2016. Continuing Versus New Prescriptions for Sedative-Hypnotic Medications: United States, 2005–2012. American Journal of Public Health, November, 106(11), pp. 2019-2025 from

Eslami-Shahrbabaki, M., Barfeh, B. M. & Nasirian, M., 2014. Persistent Psychosis after Abuse of High Dose of Zolpidem, s.l.: Addict Health from

Hoffman, F., 2013. Benefits and risks of benzodiazepines and Z-drugs: comparison of perceptions of GPs and community pharmacists in Germany. German Medical Science, 18 July.Volume 11 from

Kaufmann, C. N., 2015. SEDATIVE-HYPNOTIC PRESCRIBING IN THE UNITED STATES FROM 1993 TO 2010: RECENT TRENDS AND OUTCOMES, s.l.: John Hopkins University from

Mayo Clinic, 2018. Prescription sleeping pills: What’s right for you?. [Online] from https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/sleeping-pills/art-20043959

Ogeil, R. P., Phillips, J. G., Rajaratnam, S. M. W. & Broadbear, a. J. H., 2015. Risky drug use and effects on sleep quality and daytime sleepiness. Human Psychopharmacology, 30(30), pp. 356-363 from

Surilla Randall, P., Timothy A. Roehrs, P. & Thomas Roth, P., 2008. Over-the-Counter Sleep Aid Medications and Insomnia. Primary Psychiatry, May, 15(5), pp. 52-58 from

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