Many people experiencing sleep problems understandably want a quick fix such as sleeping pills.
Several of the successful behavioral treatments for insomnia are time-intensive and require a lot of work, which is why the thought of a pill that might solve the problem quickly is appealing.
However, doctors say sleep medications don’t cure insomnia, and in some cases they can actually exacerbate the problem over the long run.
“Sleeping pills should be used as a last resort,” said Dr. Kirk Panneton, vice president of medical affairs and chief medical officer at St. Clare’s Hospital. “Sleeping pills will put people to sleep, but they don’t necessarily guarantee them the proper sleep.”
When people fall asleep, they need REM sleep to dream.
“A lot of sleep aids will not give you that cycle of sleep. So you are actually sleeping, but you’re not sleeping appropriately,” said Panneton. “So again, it’s better to try to sleep through natural means as much as possible.”
Time to rejuvenate
Just how much sleep does the average adult need every night to feel refreshed?
Generally speaking, people need six to seven hours of sleep to function well during the day to feel alert and have no difficulty with focusing, said Dr. Martha Boulos, assistant professor of neurology at Albany Medical Center.
“People really do rejuvenate when they go through the deep stages and REM stages of sleep,” said Boulos.
Boulos said people who wake up in the morning yawning and feeling fatigued might have a sleep problem that needs to be addressed before sleeping pills are prescribed.
“After an evaluation with your doctor, if you find that there are no respiratory disorders or other medical or psychiatric issues that are keeping you awake at night, at that point you might want to consider sleeping pills,” she said.
When sleeping pills are used to help initiate sleep or help people stay asleep, doctors say they try to keep the dose to the minimum that’s required because of possible drug interactions, development of drug tolerance, development of drug dependence, physical side effects such as daytime drowsiness and withdrawal symptoms.
The Food and Drug Administration also warns that some people who take the popular drugs Ambien and Lunesta report problems with sleep walking, sleep eating and sleep driving.
“So in addition to prescribing sleeping pills, we have patients make lifestyle changes,” Boulos explained.
Some of these changes include cutting down on caffeine, exercising regularly and doing relaxation techniques such as meditation or yoga.
“Generally speaking, once things improve, we try to cut down on the sleeping pill doses and see how patients do,” said Boulos.
Rhythm messed up
Panneton said one of the reasons that it becomes more difficult for people to get a good night’s sleep as they age is they generally become less active.
“We sit around a lot more, we nap during the day and because of the physical inactivity, our sleep needs become less,” he explained.
As a result, our bodies’ circadian rhythm or internal sleep clock gets out of balance, and people have trouble sleeping.
If you do use sleep aids, Panneton suggested using them for as short a period of time as possible.
“They’re not generally meant to be used for long periods,” he said. “People can become dependent on them. Most people do not become truly physically addicted, but they may become psychologically addicted.”
Because sleeping pills tend to lose their effectiveness over time, Boulos said she has some of her patients take half a pill when they go to sleep and the other half if they wake up during the middle of the night.
“It’s safer to check with your doctor before you take any medication,” said Boulos. “You can’t say for sure if a patient who is on different medications won’t have any side effects from even over-the-counter sleep aids.”
When Marilyn Resnik, 77, of Colonie, started using sleeping pills about 25 years ago, she never thought she’d still be on them.
“I was going through a divorce, and I was worried about how I was going to put my three children through college,” said Resnik.
Originally, she tried Halcion, which lost its effectiveness after a time. Then she tried several different anti-anxiety medications in the benzodiazepine family, which did nothing.
Since then, she has tried Ambien, and Lunesta, which she currently takes.
She also recently learned some yoga positions, which she does every morning and night at her home, and she exercises at a fitness club. She cut out all caffeine and only drinks herbal tea.
Since she started exercising and practicing yoga, she has dropped from 3 milligrams to 2 milligrams of Lunesta. Her goal is to eventually be off medication entirely.
She now is sleeping about six hours a night.
“I really don’t feel refreshed in the morning until I go downstairs and do my yoga sun salutations,” said Boulos. “Then I’m fine. I wake right up.”
All patients different
When dealing with sleep, every patient is different, said Boulos.
“But I try to reassess them every two to three months to see if they have any other issues and see how they are sleeping. I also try to see if they are following the relaxation exercises. We don’t want to lose the effectiveness of the medications and get to a point where nothing works.”
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