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.
Hi Sebastian,
What about prescribing melatonin? Many patients in the hospital request sleeping tablets because they can’t sleep (presumably because of the loud hospital environment with many patients around you disturbing your sleep). What would you recommend in this situation? If you are prescribing sleeping tablets, how many days max would you prescribe them for?
Melatonin is harmless, so can be worth trying, especially if the patient is demanding something. Personally, if I had a patient who couldn’t sleep because he’d been admitted to a loud hospital ward, and I felt it necessary to prescribe one of these drugs, I’d limit it to something like five days at most.
While I agree with you in principle, not all cases are this simple. I had a baby that slept badly for 3 years. In the end I couldn’t go into deep sleep anymore – I was always half awake listening for the crying. Zolpidem assisted me to get into deep sleep again. But I was very careful to stay at 1/2 a tablet every second night. I do agree that doctors prescribe these pills very easily and will give you a repeat script as long as you want one.
Thank you for this excellent article on a most important subject. My 79 year-old stepmother was prescribed Zolpidem/Ambien for thirty years (no, that’s not a typo). Of course I blame her doctors. Needless to say, her cognitive function has gone downhill, and it seemed to degrade further at an exponential rate this past year, after she took those stupid C19 injections, then snuck off and got a third shot/booster, about six weeks after having contracted the virus. Coincidence? We’ll never know, but I don’t think so. I’ve finally convinced her to take no more prescription pills for sleep; trying melatonin and a couple of other things. But the damage has been done.
Please supply evidence that your 79 year old grandmother suffered physically due to a benzo. Short term use I think is justified. Be even clearly long term use in neurological dysfunction, as severe panic disorder.
I am saddened that this is the first time I have seen the young Dr Rushworth resort to cookbook medicine. I medically retired after 43 yrs of practice. I always gave patients the benefit of the doubt until THEY proved me wrong. And invariably some did, and were asked to leave, kindly. Most were adherent and very very well. I believe your comment is , well, quite over generalized. I prefer to relieve suffering in almost any manner, until proven otherwise.
With sincerity,
Larry W Banyash, MD. Retired
I said she was my 79 year old STEPmother. You want me to provide evidence that 30 years use of Zolpidem/Ambien harmed her cognitive health? Exactly what kind of evidence would convince you? This isn’t a court of law. Good heavens. Why don’t you read the information and evidence provided by the actual manufacturers of that drug, which state people shouldn’t use it longer than two weeks? And they single out elderly females as being especially vulnerable. Also, your sentence which begins ‘be even…’ doesn’t make sense.
I love this comment Dr. Larry. I wish more docs would try to alleviate suffering as you do
Hi Sebastian,
when I read your article I suppose you never had any difficult sleeping problems yourself.
Im absolutely not for using sleeping pills regularly or with lighter sleeping problems but if you had big problems for a long time, caused by menopause, stress and fatigue symptoms and even if the stress is gone since a couple of years the body haven’t really understood that.
So at special occasions, maybe once every second or third week, I take a half sleeping pill when waking up in the middle of the night and I after like one hour still not had fallen asleep again.
I’ve really tried to work with myself a lot to achieve a good sleep and I’m well on my way, even sold my company because I understood that causes a lot of stress for me, but it takes time and the body very easily remember the stress feeling from before.
So what Im saying is, like with most drugs its individual how you handle it and sometimes you need some “help” even if you know its not the best help, like most ordinary medicine that only keeps your symptoms away and not healing the underlying cause.
PS Ive tried melatonin as well and it doesn’t work for me. A big amount of a good magnesium is the best help normally.
Normally I agree with you in most subjects 🙂
Concur with you re Dr S , in most cases. As an ER doc he his practice is already skewed to the worst of the worst clinical cases….or by absurd hosp mandates advising docs how to practice medicine….COVID a case in point…. I think he needs to think, with all due respect, about his own personal judgement calls that clearly affect another’s health. Imho
Sincerely
Larry W Banyash MD retired
Thank You Sebastion!! We truly are living in a irresponsible pill culture here in the USA. I wish you were my doctor.I seem to wake up every few hours no matter what. I can avoid caffeine, alcohol ,and tire myself out with exercise all I want but I still can’t stay in a consistent sleep pattern. I seem to also wake up every night/morning at around 3:00 AM hungry. After a small snack I can usually sleep through the rest of my resting hours but still awaken often. My blood sugar is always a little high first thing in the morning but normal the rest of the day which is perplexing. My only hope is to take a child’s dose of Benadryl every night (12mg). Even then I never feel like I’m in a deep sleep. I also have sleep apnea but have been on C-pap therapy for twenty years which has eliminated my daytime fatigue completely. My father also could not sleep well. Thank-You for this article but it offers no solutions and neither do my doctors except offering me sleeping pills which I won’t take.
I just recently listened to a health program (in German unfortunately) where the doctor said that if you wake up regularly at around 3 am you might have liver issues. At that time the liver is most active.
Perhaps worth to do some blood tests and have a look at the liver values?
Interesting. Claudia und Maya in Schweden
In Traditional Chinese Medicine a Chinese “meridian clock” is used to show the times of day when each organ system is most active.
This is what it says:
1am-3am – Liver
3am-5am – Lungs
5am-7am– Large intestines
7am-9am – Stomach
9am-11am – Spleen & pancreas
11am- 1pm – Heart & mind
1pm-3pm – Small intestine
3pm – 5pm – Bladder
5pm -7 pm – Kidneys
7pm – 9pm – Pericardium
9pm- 11pm – Triple heater (related to metabolism)
11pm- 1am – Gallbladder
I have had regular blood tests and my liver is always in the normal. I also take a SAMe supplement which supposedly supports liver health. I also eat dandelion salads and don’t drink much Alcohol. So I’m not sure its my liver or not.
Well, a lot of doctors say that even too much carbs could cause issues with the liver. (Dr. Sten Ekberg on YouTube is really good in explaining how the body works!)
But when you check your blood values regularly then your sleeping issues probably have another cause. Keep my fingers crossed that you soon get over your sleeping issues.
That is your choice. Please do not automatically vilify those who may medically need a benzo—for whatever reason
Sincerely,
Larry W Banyash MD, retired
Where were they ‘automatically vilified’?
Hi Tony, it souds a bit like the problem I used to have. The thing that helped me was to change what I was eating. If your stomac doesn’t work in a proper way your body wont get the nutrients it need and you will feel a hunger because of that.
Since I cut out suger, bakery, wheat (gluten) and eat good fats (butter, coconutoil etc) and lots of greens etc I feel much more energized during the day and sleep good at night.
If I start chaeting it will effect my sleep directly. For me it is a small price to pay to get my health back.
I hope that you also will find your way to good sleep.
Thank-you Mattias Millqvist for taking the time to write advice,. but I do eat the right high nutritional foods too so again despite all the good advice I still can’t sleep. I take Benadryl at low doses (one half a tablet)and my cognitive ability seems good even at my age of 67. I realize taking Benadryl has been implicated as one of the bad guys for cognitive health but it’s the only thing that works in turning me off at night but when it wears off I wake up and I won’t reload with more of it. I tried the usual mainstream prescriptions like Gabapentin,Ambien and Anti-depressants and none helped and all had side effects. I refuse to take prescription drugs for my condition anymore . My doctor thinks sleep is important and worth the risk of taking the drug he recommends but they simply don’t work for me. Melatonin is a fail too. I guess it has something to do with my sleep apnea. Otherwise I am very healthy. Thanks again.
I don’t know whether I had a sleeping problem, but every morning I woke up feeling tied up in knots and exhausted. My naturopath prescribed Cortisol Manager by Integrative Therapeutics and it really seems to help. I wake up no happier about the state of the world, but it doesn’t feel like I’ve spent the night wrestling with it.
Spot on again Sebastian
Not really, cookbook for the younger docs worried about their own reputation or medical license.
Sleep is an extraordinarily complex mechanism—still in its infancy of research. Truly, don’t throw the baby out with the bath water.
Most sincerely,
Larry W Banyash MD, retired
It is amazing to me how mainstream medical doctors can’t seem to be able to think outside of their training and see alternatives to poly-pharmacy solutions. All a doctor ever offers me as a solution is a pill. Most don’t solve the problem and have side effects. I wish doctors were better trained in nutritional alternatives.
Some years ago my wife was prescribed Lorazepam for anxiety, and she shortly became more anxious and addicted. With no help from our doctor or any official support she managed to recover from her dependency on the drug. It took 15 months and was very painful, physically and psychologically. I agree with everything you say from my own experience as her carer. My advice would be to keep away from benzos in any guise.
Totally agree, Peter. I lived with someone who was addicted to benzos and his dr just kept prescribing more and ending up with 4 times prescribed daily dose. It was a living hell for me and when I complained to his Dr I was told ” he needs them”. Changed doctors and admitted him to hospital to reduce the dosage. That didn’t work so for my own safety I left him.
A great topic Sebastian! I agree that people are often looking for the quick fix/ magic pill rather than the underlying reason and what suits their body. I used to sleep anywhere for a good long time 8-10 hours but now my night is often broken or I wake very early. I’m not stressed by this instead I use the time to read or do puzzles until I’m ready to sleep or to get up. I don’t feel exceptionally tired in the day even after maybe 4 hours sleep. Our body changes so why do we feel we need to conform to a conventional 8 hours sleep? Surely anxiety about not sleeping just makes everything worse?
I agree fully with you Sebastian. And sleeping pills, I have read, do not give you the same quality of sleep as natural sleep?
what is you opinion on using Gravol as a sleep aid. Our doctor says it’s non-addictive, has no other side effects, and can be used frequently for periods if necessary. For example, as an aid for those who experienced a trauma such as the death of a loved on, and who are having difficulty sleeping. Some people only need to take 1/2 a tablet, 30 minutes before bed, others take a full tablet.
Thanks for you thoughts.
My best,
Brian
Gravol is an antihistamine, so it’s correct that it’s not addictive and has some sedative effects. Like most antihistamines used to induce sleep, it also has some anticholinergic effect, which can negatively impact cognitive function, especially in the elderly.
I have very good results with an audiobook, which I have published since 2007. It contains calm speech with various sleeping metaphors. It has been distributed in thousands of copies. I developed it together with a woman who before that had had severe sleep problems, including the use of sleeping pills. She is now living without any sleep problems.
Excellent article not just about sleeping pill but about overall approach to health. Medication has its role but finding the underlying issue is a priority. More complex than pills but much more worthwhile. Alas, that is not how the healthcare system works.
Totally agree Adriana, bandaiding never works. Doctors should spend time getting to the root cause. Sleeping issues can be an adrenal problem . Too high cortisol will keep anyone awake. Hardly any doctors know about the 4 point saliva cortisol test which pinpoints cortisol levels in a 12 hour period. High or low cortisol at the wrong time of the day has an effect on thyroid hormone production which then affects metabolism.
Hi Sebastion, thanks for your excellent work. I really admire your courage to speak out the facts. You are one of the men with the genius to recognise what is wrong and the courage to speak out. We need people like you and I believe that the majority of people recognise truth when they see it, even if it it takes a while to sink in.
Thank you for your warnings about sleeping pills. I mainly share your opinion, but I think there is a difference between a long lasting sleeping problem and an acute situation disturbing normal sleep. Like jet lag or transient worries about something. I think that a single small dose (3,5 mg) of for example Imovane will get you on «the right sleeping track». My experience is that even one nights bad sleep has negative effects for several days and nights.
Sebastian, You remind me of 42 years fighting like Don Quichote against the windmills concerning sleeping pills. But I had at least 1 (one) success: After a long talk about sleep problems a patient asked me to have some pills “just in case”. I prescribed a small amount of benzodiazepin drops, because he knew now, what the risks of this drug are. After a couple of weeks he showed up and said: “The best drug I ever had – it still sits on my nightstand and I look at it and know a can take it if necessary – and suddenly I fall asleep.”
What would be so bad about this particular addiction? If you take antidepressants you’re addicted too. I can understand maybe in the case of a younger person, but if you are old what does it matter if you die addicted to a sleeping pill, especially since these cost next to nothing.
Well if the sleeping medication substantially increases the risk of falling (one if the highest risk factors for the elderly) and getting dementia, is it still worth it? According to some studies those side effects are common, for certain types of sleep meds. In my view more natural products such as melatonin, 5HTP, GABA, magnesium or an antihistamine and of course altered habits should be tried first.
Indeed risk of falling is the only valid argument I can see for people who get really old and frail. Not sure there is scientific evidence that Z drugs increase risk of dementia. I’m sure though that lack of sleep is not good at all for people with depression.
I have used GABA powder for almost a year and in my experience it is quite helpful. It helps me fall asleep , but it induces sleep in a somewhat mild way and I need to keep practicing good sleeping habits. If I am too stressed it doesn’t work. If I understand correctly GABA (Gamma-Aminobutyric Acid) is a neurotransmitter that blocks impulses between nerve cells in the brain. Be careful to take the correct dosage if you try it, since side effects may occur, such as affected breathing and Tingeling of the skin. It fades away after 10-15 minutes in my experience.
You can also get it from tea fermented specially to increase its GABA content
https://en.wikipedia.org/wiki/GABA_tea
I find it very relaxing occasionally and dont seem to be addicted. Coffee in the morning, is another story however…
I’m puzzled by the reference to high blood pressure of which I have. I am not overweight (5’7″, 130 lbs), am active (walk 3 miles every morning), eat healthy meals I cook myself, don’t own a TV. This is my lifestyle for my entire life. My blood pressure started creeping up in my late 40s. I’m now 70 and have been taking medication to lower it for years. I am clueless as to what more I need to do!
I’m not saying that there aren’t situations where blood pressure lowering drugs don’t have a place. If you’ve made all the necessary lifestyle modifications and still have high blood pressure, then a blood pressure lowering drug might be right for you.
The problem of sleeping pills encapsulates the whole of drug prescription, including “vaccines” against Covid. As you say, there is medication, but there is still a problem.
Tryckfelsnisse har varit framme: “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”
Over twenty years ago I was prescribed a total of 14 sleeping pills. I only took them when I was desperate and really needed to sleep (for example a long drive to do the following day, or some other important reason why decent rest was needed) and I was too stressed to fall asleep without. Some years after their best before date I threw away the unused pills. Despite not taking any other prescription medicines my GP has refused me a repeat prescription so that I have a small supply of sleeping pills for very occasional use. I have no history of addictive behaviour and they must know after many years at the practice that I don’t believe in popping pills unless I truly need them. Even my migraine painkillers are taken at minimal levels and only for my most serious attacks, However my mother, my sister and various friends all seem to get sleeping pills prescribed without difficulty. Is this something to do with me or a lottery depending on which GP you happen to see?
I don’t really approve of dosing myself with over the counter medication but may have to resort to this for an emergency supply. I’d be interested to know what is suggested (UK availability). If my level of tiredness the next day isn’t important I listen to an audio book (one where I know the story so I can drift off to sleep rather than try to stay awake to find out what happens). But I often wake up not feeling refreshed. And sometimes being grossly overtired the next day really does matter and can be dangerous.
I agree that care should be taken over prescribing addictive drugs but they have their place for occasional use and a blanket ban is depriving people of the benefits of pharmaceutical advances. Some of us patients are sensible and read the small print and contra-indications. Why are we all considered too stupid to be trusted? Sleep is good for us and sometimes we do need help.
I wonder if this will be one of your more controversial topics?
My GP too refused to prescribe, let alone a repeat prescription. My wife has one from her GP with no different need than mine I would say. So I have turned to the black market…
I just wanted to say that I really appreciate your work!
I second that Sebastian. I love your video interviews too but reading your writings is quicker for me as I sometimes can’t sit still long enough to watch the videos one time but I do it in segments. Please keep doing what your are doing both in writing and in interviews.
Hi Sebastian,
Good advice to avoid prescribing or taking anything addictive and as far as I know you are right about some magic bullet for sleeping problems. There are two things that I have discovered over the last year, though, that do seem to help when I wake up in the middle of night.
1. Non-sleep Deep Rest/ Yoga Nidra – these are simple scripts 10-20 minutes long that consist of a series of deep breathing and ‘situational awareness’ exercises (checking on your body parts). Once you learn them, you don’t need the scripts and can run through the routine on your own. Essentially, they allow you to relax and take you mind off whatever is worrying you.
Andrew Hueberman is a big proponent of these routines. I was skeptical, but gave them a go and they do seem to help: I can get back to sleep in the middle of the night about 75% of the time. I don’t usually have a problem falling asleep at my routine time, but NSDR does seem to help then too.
2. The two sleeps hypothesis (duckduckgo ‘Medieval Sleeping Habits’ should get you there). There was a flurry of articles in the MSM (BBC, Atlantic, etc.) on how records indicate that European sleeping patterns were commonly divided into an early sleep and then an awake period around 1-2 am and then a later sleep.
I’m highly suspicious of the sudden flurry of articles, but not about the hypothesis that a mid-night wakeful period is normal. It has always been normal for me – and very useful when a pot-bellied stove or campfire had to be stoked. Also, it isn’t uncommon to find some similar pattern in biographies of famous men using middle of the nights for extra reading for example.
The main reason this is helpful is that it tends to eliminate the stress about waking up in the middle of the night. If it is natural, then why worry? Do something useful until you are tired again.
If the 8 hour dogma is wrong, then it would be nice to see some research that challenges it – most current sleep research seems rather circular to me.
I recently discovered on youtube Huberman Lab #43 Timing Light, Food, & Exercise for Better Sleep, Energy & Mood and am hoping it will help me with deep sleep. I’ve tried most of the suggestions here in the comments including ashwaganda, L-theannine. Years ago I read that exposing oneself to the morning sun will help one fall asleep quicker and exposing oneself to the setting sun will enable you to stay asleep longer.
Dana
You are definitely on to something. I’ve noticed I sleep better in the summer when I expose myself to sun during the morning and daytime. Winter time seems when my sleeping issues are the most common and severe.My doctor suggested I may have Seasonal Effective Disorder and suggested I take Bupropion an anti- depressant but it didn’t help. I had nighttime tremors while on it.I purchased a light therapy lamp and it does help a little but I’m not consistent using it as I should be as you have to find the time to sit by it closely for about 30-45 minutes which I sometimes find hard to do. . It doesn’t always work however for me regardless. My doctor checked my Vitamin D levels and they were low. I am supplementing with D and that gave me even worse insomnia at first. So now I take a dose in the early morning with better results. Some people claim vitamin D supplementation helps them sleep. I also have tried magnesium.As someone else stated perhaps waking up at 3:00 AM is a normal part of the sleeping process for us. I do worry about being hungry at that time however as my blood sugar is a little elevated in the morning. Exercising late in the day makes it harder for me to sleep . My doctor says exercising before bedtime is beneficial. My doctor tells me I am very healthy……except for the on-off insomnia mystery.The comments here are helpful. Thanks To All!! Sorry for such a long post.
Years ago I did a survey of hospital patients wrt pain (about 2000 randomly selected). One of the striking results was that if someone was suffering pain, he/she was much more likely to have been prescribed a sedative. Talking to staff indicated that they believed analgesics to be more addictive than benzodiazepines. Furthermore, I knew physicians who were investigated for analgesic prescriptions, but never heard investigations for sedative prescriptions.
When the reason for sleep problems is physiological treatment should be focused on the problem. It is daft, as one commentator above mentions, to treat menopausal symptoms when effective hormones are available. It is also not unreasonable to prescribe sedatives for short periods of stress.
Sebastian, please have a look at this new study “Persistent Cardiac MRI Findings in a Cohort of Adolescents with post COVID-19 mRNA vaccine myopericarditis” published in Journal of Pediatrics on March 25th.
jpeds.com/article/S0022-3476(22)00282-7/fulltext#relatedArticles
Here is a comment to the study “A new peer-reviewed study shows more than two-thirds of adolescents with COVID-19 vaccine-related myopericarditis had persistent heart abnormalities months after their initial diagnosis, raising concerns for potential long-term effects.”
Why bring Covid into everything? This article is about sleeping pills.
Cognitive Behavioral Therapy is remarkably effective for insomnia, and is backed by plenty of evidence. Any physician trained in sleep medicine would know it’s the preferred treatment. Anecdotally it fixed my six months of horrific insomnia within a couple of weeks. As long as the patient is disciplined he can fix sleep problems without any medicine. In fact, a doctor isn’t even required as the process is easy to follow and can be learned from a one hour YT video.
In the West, we might be better suited to use this adage: “A Patient Cured is a Customer Lost.”
Western medicine isn’t designed to cure or treat anything. It is designed to alleviate symptoms through the offering of medication (which cause further, potentially unrelated symptoms in other body systems). There are no cures that come from pharmaceuticals. Cure is to be found in health – which is to be found in diet (clean, whole foods that aren’t overly processed) and exercise (activity that is mindful and meaningful to the individual). I believe Dr. Rushworth clearly delineates this in most of his posts here.
You are probably right, but there may be situations where alleviating symptoms is good enough.