I hate sleeping pills. I really hate them. The negative emotional response I get when I see them in a patient’s chart is much stronger than what I feel when I see pretty much any other drug. In particular, there is one class of sleeping pill that I really hate, and that is the weirdly named “nonbenzodiazepine”, which is basically a benzodiazepine (a highly addictive sedative drug) but which as been marketed instead as a sleeping pill. Common examples of nonbenzodiazepines are Imovane and Ambien.
Why do I hate them so much?
Well, because they’re used so irresponsibly by both doctors and patients. The big problem with these drugs is that they are absurdly addictive, and that tolerance develops after just days of use. So, while Imovane or Ambien may help you fall asleep a little bit faster, and sleep a little bit longer initially (the effect is actually quite marginal, less than half an hour), that beneficial effect is completely gone after just a few days or weeks of use.
What that means is that the amount of sleep you are getting is equivalent, after just a few weeks, to what it would have been if you’d never taken the drug in the first place. On top of that, you’ve now developed an addiction – if you don’t take the drug, your sleep will be much worse than it would have been if you’d never taken the drug in the first place. And once an addiction to a nonbenzodiazepine has developed, it is very hard to stop. Which is why so many people end up addicted to these drugs.
An elderly colleague once said to me that if you want to have a good life as a doctor, then you should refuse to ever prescribe addictive drugs to anyone, especially addictive sleeping pills. That way, the addicts will soon realize that they won’t get anywhere with you, and they’ll go elsewhere. Of course, that doesn’t remove the problem, it just shifts it on to someone else’s plate. But at least then you’re not contributing to the problem by producing new addicts.
Sleeping pills are basically band-aids. They do nothing to solve the underlying problem. If you have a sleeping problem and you take a sleeping pill, then even if the pill works, you still have a sleeping problem. Nothing has changed. What people need to realize is that there is no magic pill that can fix your problems for you. That is true for everything, not just sleep. A statin won’t fix your heart disease, a blood pressure lowering drug won’t fix your high blood pressure, and a glucose lowering drug won’t fix your diabetes. They’re all band-aids, and pretty ineffective band-aids at that. What you need to do, if you have a health issue, is to start taking responsibility for your own health.
There are antihistamine-based sleeping pills that aren’t addictive, it’s true, but they’re still just band-aids, and while they may help somewhat with sleep (the effect is pretty marginal, as it is for most other types of drugs), they interfere with sleep architecture and worsen cognitive performance, just like the addictive sleeping pills do.
If you have a sleeping problem, then first you need to ask yourself, what is causing it?
Is the problem alcohol? Well, then you need to cut down your alcohol consumption. Is the problem that you’re not physically active enough? Well, again, the solution is simple. Start moving more. Tire yourself out enough during the day that your body is ready to sleep at night. Is the problem anxiety about having to go to a job you hate in the morning? Change jobs!
And make sure you have good sleep hygiene. Avoid screens close to bed time. Sleep in a dark, cool room. Don’t get in bed until you’re truly tired enough to fall asleep, and if you can’t fall asleep naturally within 15 minutes, get up again and read a book until you are tired enough to sleep. Set an alarm and get up at the same time every day (even weekends).
If you have a sleeping problem and your doctor tries to prescribe you a sleeping pill, ask why they are prescribing it and if they think it’s really necessary. Most likely the reason is that they think you expect/want a prescription, and they don’t think it’s really necessary. Then ask if you can get a referral for sleep therapy instead. Unlike sleeping pills, sleep therapy really does work to improve sleep over the long term.