The Ultimate Guide to Drugs and Sleep: What are the Real Impacts?

People spend about a third of their life sleeping.

Sleep is governed by two internal mechanisms: a circadian rhythm (biological clock) and the body’s attempt to achieve homeostasis (balance).

THE USE OF MEDICATIONS TO AID IN SLEEP

Even though sleep is an essential part of life, many people do not receive enough sleep or do not get the type of quality sleep they require.

According to the U.S. Centers for Disease Control and Prevention (CDC), nearly one out of three Americans does not get adequate sleep.

Sleep aids are part of a huge industry, generating billions of dollars per year.

One of the most common approaches to assisting with sleep is to use some type of medication, such as a prescription or over-the-counter drug.

While they can be effective, there are significant downsides to using medications to fall and stay asleep.

COMMON SIDE EFFECTS OF SLEEP MEDICATIONS 

There are numerous side effects associated with using medications as aids for sleep. All medicines that are designed to help sleep have potential side effects, which vary depending on the specific type of drug, how long the drug remains in a person’s system, the dosage, and individual differences in metabolism and other physical and mental factors.

The most common side effects of medications for sleep include:

•  Being drowsy the day after using the medication
•  Experiencing aches and pains following use
•  Issues with concentration, dizziness, unsteadiness, dry mouth, and even rebound insomnia

OTHER RISKS OF USING MEDICATION FOR SLEEP

Many medications that are used to induce or maintain sleep carry more severe risks. This includes both over-the-counter drugs and prescription medications.

According to the National Sleep Foundation, some risks are very serious.

RISKS OF USING MEDICATIONS FOR SLEEP

•  Tolerance to the effects of sleep medications
•  Negative interactions with other types of drugs
•  Cannot sleep without them
•  Potential to induce physical dependence
•  Sleep medications are notorious drugs of abuse

Certain types of sleep medications may cause allergic reactions.

Some medications have the potential to produce very complex and potentially dangerous sleep-related behaviors, such as parasomnias (walking, driving, cooking, and performing other activities while asleep).

Prescription sleep medications may produce feelings or behaviors that are often associated with severe psychiatric disorders, such as hallucinations, suicidal thoughts, or mood swings.

OVER-THE-COUNTER SLEEP AIDS

Over-the-counter (OTC) medications often rely on antihistamines as the active ingredient to promote drowsiness. Antihistamines are also used to treat allergies.

One of the main issues with antihistamines is that their effects are long-lasting, and individuals who use them may feel drowsy or even feel like they have a hangover the following day.

They may also produce:

•  Headaches and forgetfulness
•  Problems with balance or movement
•  Issues with constipation
•  Dryness in the mouth or throat, blurred vision, and/or nausea

Over-the-counter medications are not designed for long-term use. People who use them for more than a few weeks should discuss their situation with a physician.

PRESCRIPTION MEDICATIONS FOR SLEEP

Several different types of prescription sleep medications are available. These drugs are often classified as sedatives, or as hypnotics.

Medications that are fast-acting and remain in the body for a short time are often used to induce sleep, whereas medications that are slower acting and remain in the body longer are often used to maintain sleep.

TYPES OF PRESCRIPTION MEDICATIONS 

Briefly, some of the classes of prescription medications for sleep include:

Benzodiazepines. These are perhaps the oldest class of medications used to assist with sleep. This class includes familiar drugs like Xanax (alprazolam) Valium (diazepam), and many other drugs. Benzodiazepines have a significant risk for abuse, tolerance, withdrawal symptoms, and overdose.

Non-benzodiazepine hypnotics. These drugs act in a manner similar to benzodiazepines, but they do not have the same chemical structure. They are believed to have less potential for abuse and physical dependence. They include drugs like Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon).

They still carry some risk for abuse and physical dependence, though the risk is not as great as with benzodiazepines. They have many of the same side effects listed above that other medications may produce.

Rozerem (ramelteon). This is a newer type of medication that works by mimicking the hormone melatonin. It has less risk for abuse and the development of physical dependence, but it carries the same side effect profile as other medications.

It may worsen depression in people who are diagnosed with major depressive disorder. Its use may also increase the risk of liver damage.

Antidepressants. Some antidepressant medications may be prescribed off-label to assist with sleep.

DIETARY SUPPLEMENTS TO PROMOTE SLEEP

The  U.S. Food and Drug Administration (FDA) does not regulate dietary supplements. Therefore, many of these substances make claims that are not backed by evidence.

There is also the potential that many of these supplements contain additives that can be potentially toxic, or they may not even include the ingredient that they claim is in it.

Nonetheless, there are numerous dietary and herbal supplements that are purported to assist with sleep.

Melatonin is a naturally occurring hormone that might be useful in promoting drowsiness in some situations. It does not have significant use in treating formal sleep disorders.

Tryptophan is a naturally occurring amino acid that is part of the building blocks for the neurotransmitter serotonin, which may be important in sleep.

Valerian root is an herb that has been used for many years to treat anxiety and insomnia. It is often used as a tea.

Chamomile tea is promoted as a natural sedative, but it may produce allergic reactions in some people.

Kava is a small shrub that has been used for many years as a medicinal substance and is purported to promote sleep.

There are many other dietary supplements and herbs that can be used as sleep aids.

Natural products are often inferred by many to be safer than medicines; however, this is not the case. Natural products often cause similar side effects to medications. They may be even more dangerous in some cases due to a lack of research and understanding of how they work.

A WARNING ABOUT MEDICINAL SLEEP AIDS

The use of medications or other dietary aids for sleep should never be considered a long-term solution. Instead, using behavioral approaches that focus on promoting healthy sleep is a more sound way of improving the quantity and quality of sleep.

Long-term use of medications results in the development of tolerance and potential physical dependence. Long-term use of dietary aids may be associated with these negative effects as well and may have unknown ramifications.

PRACTICE SLEEP HYGIENE

Instead of using medications or other supplements to assist with sleep, many organizations suggest that people should develop good sleeping habits. This is known as the use of a sleep hygiene program.

SLEEP HYGIENE PROGRAM CHECKLIST

• Keep on a consistent schedule where you go to bed
•  Make sure that you get at least seven hours of sleep
•  Establish a routine before bedtime that helps you to relax
•  Do not consume alcohol before bedtime
•  Reduce stimulation in the room where you sleep
•  Only use your bed for sleeping and sex
•  Maintain a healthy lifestyle
•  Limit the use of sleep medications, dietary supplements, and herbs to promote sleep

SLEEP THERAPY 

Different types of therapy can be used to improve the quantity and quality of sleep. These are typically cognitive-behavioral methods.

SLEEP THERAPY TECHNIQUES

•  Try progressive relaxation techniques
•  Use abdominal or diaphragmatic breathing
•  Address stress in therapy to assist with sleep
•  Use cognitive restructuring to change dysfunctional thoughts

Research has suggested that the use of cognitive-behavioral techniques is even more effective than prescription medications in improving the quality and quantity of sleep over the long term. Other forms of therapy may also be useful in promoting healthy sleep.

THE STAGES OF SLEEP

There are generally four to seven identified stages of sleep, depending on the researcher.

THE FUNCTION OF SLEEP

Sleep is essential. Even though sleep researchers have debated the various functions of sleep, there are many recognized functions that sleep serves.

Some of the more important functions that occur during sleep are:

• Brain development. Research has suggested that people who get inadequate levels of sleep may be prone to problems with disinhibition, severe depression, and cognition.
• Memory consolidation. The formation of new memories based on learning experiences occurs during sleep, with much of it happening during REM sleep.
• Healing functions.
• Maintenance of hormone levels and strengthening of the immune system.
• Physical growth (for younger individuals).

HOW MUCH SLEEP DO PEOPLE NEED?

The amount of sleep a person needs depends on many variables.

Perhaps the most important factor related to the need for sleep is the person’s age. Babies often sleep as much as 16 to 18 hours per day, whereas children and adolescents require nine to 12 hours of sleep per night.

Most adults typically require between seven and nine hours of sleep. As they age, their sleep cycle tends to be shorter, lighter and is interrupted by multiple wakings during the night.

SLEEP DISORDERS

A sleep disorder is a real mental health disorder or neurological condition that interferes with a person’s sleep-wake cycle. There are several formal recognized sleep disorders that include:

•  Narcolepsy, episodes of daytime sleepiness and/or a period
•  Chronic insomnia or difficulty falling asleep
•  Chronic hypersomnia where the individual has excessive sleepiness
•  Obstructive sleep apnea, which is characterized by daytime sleepiness and nocturnal breeding disturbances

The recognition of a sleep disorder requires a formal diagnosis by a physician. It will involve a specific course of treatment that often includes a combination of medicine and behavioral interventions.

Unlike individuals who do not have diagnosable sleep disorders, those with diagnosed sleep disorders may often need long-term treatment with medications and behavioral interventions.

Sources

(April 2016). Functions and mechanisms of sleep. AIMS Neuroscience from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390528/

(2019). How Much Sleep Do We Really Need? National Sleep Foundation from https://www.sleepfoundation.org/excessive-sleepiness/support/how-much-sleep-do-we-really-need

(February 2016). 1 in 3 Adults Don’t Get Enough Sleep. U.S. Centers for Disease Control and Prevention from https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html

National Sleep Foundation. from https://www.sleepfoundation.org/ (February 2019). Antihistamines. WebMD from https://www.webmd.com/allergies/antihistamines-for-allergies

(January 2018). Prescription Sleeping Pills: What’s Right for You? Mayo Clinic from https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/sleeping-pills/art-20043959

(August 2015). The role of Sleep Hygiene in Promoting Public Health: A Review of Empirical evidence. Sleep Medicine Reviews from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4400203/