Do you find yourself reaching for another sleeping pill or promising yourself that you’ll get some the next day?
I know from experience that this is a natural reaction to the stress of not sleeping. When insomnia starts making life difficult, it’s natural to want to fix it as quickly and effectively as possible.
But are sleeping pills the best option? And do the benefits of taking them outweigh the risks?
If you search the internet you’ll find lots of advice about the risks of taking sleeping pills, especially over a long period of time. And recent medical research into the potential side-effects suggests it might not always be such a good idea.
It’s of course very easy to take the moral high ground and say sleeping pills are bad for you and you shouldn’t take them. But if they’re the only way you’ve found to ensure you can get some sleep, then I can see why you might decide to accept the risks.
In this article I’ll cover some of the main advantages and risks of taking sleeping pills. I’ll also look at some important statistics regarding sleeping pill use among adults, and alternative approaches you can try.
Do remember though that if you’re currently taking prescription drugs, it’s important to consult your doctor before stopping or changing your dosage.
How many people take sleeping pills?
In 2013 the U.S. Department of Health and Human Services sponsored a large US study into prescription sleep aid use among adults. The drugs included sedatives to reduce anxiety and specific sleeping pills.
They found that 5% of women in the USA and 3% of men reported taking prescription drugs over the last month to help them sleep. That equates to about 9 Million adults a year taking pills in the US alone.
As shown in the chart below, on average more older people took sleeping pills than younger people.
In 2012 the Royal Pharmaceutical Society in England reported on a survey of over 2000 people about their sleep problems.
Their research suggested that 51% of people with insomnia had self-diagnosed and then bought over the counter sleeping pills without consulting their doctor first.
The survey also found some worrying trends with people taking sleeping pills for long periods of time:
- 30% of the people who said they have insomnia had been taking sleeping pills for more than a month without advice from a professional.
- 14% of insomniacs had been taking sleeping pills for over six months.
- 18% of the people couldn’t even remember how long they’d been taking them for.
They also identified that 70% of people didn’t know, or were wrong about, how many health conditions can lead to insomnia. In fact, for chronic insomnia, which lasts longer than a month, only 1 in 5 cases are not related to another health condition.
For the other 4 out of 5 people, it’s an underlying health condition which is either creating the insomnia or existing alongside it, making it harder to treat.
In the United States, 1 in 10 people will suffer from chronic insomnia (lasting longer than a month) at some point in their lives.
In a country where access to healthcare is much more difficult than the United Kingdom, you might expect an even higher ratio of people to be self-diagnosing and buying sleeping pills than in the UK survey.
That might explain why in 2010, sleeping pills and related medicines accounted for 30 billion dollars in the United States.
Arguments against taking sleeping pills
The arguments most often quoted against using sleeping pills include:
- They may mask an underlying medical condition which is interfering with your sleep. Experts say that the priority should be to identify the root cause of your sleep problems.
- They can have worrying effects on your health and even increase your risk of death or cancer (see below for more about this).
- Your body can rapidly build a tolerance to the drugs, meaning you have to keep increasing the dosage for them to work effectively.
- Some of the drugs can be addictive and therefore difficult to eventually stop taking them.
- Your insomnia or poor sleep quality can be even worse when you stop taking sleeping pills.
- They can affect your mental state the next day, leading to lower levels of concentration and higher risks of having an accident.
- Sleep experts say that sleeping pills might make you fall asleep and stay asleep. However, they don’t guarantee you’ll get the right type of sleep. For example, they may reduce your quantity of deep restorative sleep (for more on this, read the article about why we sleep).
- They can interact with other drugs, so you need to be careful if you’re on other medication.
There are also reports which suggest that drinking alcohol at the same time as taking sleeping aids is very often a bad idea. I’ll cover some of these points in more detail later in the article.
Reasons why people take sleeping pills
Despite knowing the risks and side effects of these drugs, tens of millions of people around the world still take them. Let’s have a look at some of the main reasons people take them:
- Anyone who’s suffered from prolonged sleep problems knows that it can have a negative impact on your physical and mental health. So when feeling exhausted, desperate or stressed by a lack of sleep, it’s very tempting to try anything which might help.
- They can be very effective in sending you to sleep quickly and keeping you asleep, even if the sleep quality isn’t perfect.
- If used for a limited period they can be effective in resetting your body clock to sleep at the right time.
- They are easy to use and don’t require lengthy routines such as relaxation techniques.
- They are convenient and many of the sleeping pills can be bought over the counter or on the internet.
- If you have other health problems which keep you awake, then a sleeping pill may be an attractive way to help you sleep.
- Most of the side effects are well known, so if you’re prescribed them your doctor should warn you about the risks.
- Many people do trust their doctor’s advice. So if prescribed a sleeping pill, they will take it believing it’s the best solution.
Before I cover some of the results about the possible health risks associated with taking sleeping pills, there are 2 important points to mention:
- Firstly, I’m not a medical practitioner and I would therefore urge you to consult your doctor before taking any action, such as stopping taking any current prescription sleeping pills.
- Most of the research studies do mention the difficulty in being absolutely sure about the cause and effect and the consequent risk of bias in the studies. For example, can ill-health result in a need to take sleeping aids rather than sleep aids actually causing health problems?
Possible issues with taking sleeping pills
Are they addictive?
The modern and most commonly prescribed sleeping tablets are not chemically addictive in the same sense as many recreational drugs or even nicotine.
However, you can develop what’s called a psychological dependence or habit forming condition. In this case, when you stop taking the pills you might find you revert back to your sleeplessness.
This can then lead to you experiencing a strong and sometimes overwhelming urge to start relying on the pills again.
For this reason, in most cases sleep experts recommend that you only take them for a short period of time. They also suggest that people should slowly reduce the frequency and/or dosage level rather than stop abruptly.
Increased risk of death
There have been a number of studies over the last few years indicating that there’s a significant increased risk of death for people taking certain sleeping pills regularly.
One of the largest cohort studies was reported in the British Medical Journal in 2014.
The team compared the medical records of 34,727 patients prescribed anxiolytic (used to treat anxity) or hypnotic drugs (sleeping pills), or both, with 69,418 similar patients not prescribed with any of these drugs.
The study looked at the patient’s records for, on average, 7.6 years. Interestingly, they also found that people are often prescribed both of these pills, namely a sedative and sleeping pill (76% of people in the study).
They also attempted to adjust their findings to allow for other health conditions which might impact on the results. This included physical and psychiatric problems, sleep disorders and use of other drugs.
Their overall findings are that people taking these types of drugs are more than twice as likely to die compared to the comparison group.
After excluding deaths in the first year, there were approximately four excess deaths linked to drug use per 100 people followed for an average of 7.6 years after their first prescription.
Of course, the overall risk of death is still relatively small.
There have been a number of studies which linked use of sedatives and sleep aids to an increased incidence of cancer.
In 2015 a group of researchers from Norway, Finland and the United Kingdom reported the results of a very large study of the use of sleep aids and risk of cancer.
They based their work on data from the Finnish Public Sector Study, which they linked to registers of cancer and drug prescription. It covered nearly 30,000 people over a seven year period, of whom 5000 developed cancer.
Their overall conclusion was that:
Sleep medication use was associated with an increased cancer incidence of the respiratory system
They also found that the risk of developing cancer increased the longer people used these sleep aids and the greater number taken. The report suggests that:
- People who took sleeping pills at least twice a week were more than twice as likely to develop cancer of the respiratory system (mouth, throat etc) than non-users.
- Long-term use, such as for over three years increased the risk even further.
- The risk was greater for older people than the occasional use by a younger person.
Sleeping pills might be masking another health problem
For example, if an illness is making someone cough all night, then a sleeping pill would not cure the cough.
And it also might not knock the person out so strongly that the cough didn’t keep them awake.
But going to a doctor, diagnosing the reason for the cough and treating it might just mean the illness, the cough and the insomnia are all be tackled at once.
Higher risk of having a car accident
In 2013 Dr Ryan Hansen of the University of Washington’s school of pharmacy reported on the outcome of a study into the links between some sleeping pills and the increased risk of having a car accident.
The team compared the medical and driving records between 2003 and 2008 of 409,171 people aged over 21 with a driving license.
Just under 6% of these people included in the study had a sleeping pill prescription for either zolpidem (brand name Ambien); trazodone (brand names include Oleptro); or temazepam (brand name Restoril).
Their findings were a little worrying:
- Those who took Restoril were 27% more likely to have a car crash over the 5 year period in the study, compared to people who didn’t take sleeping aids.
- Those who took Trazodone or Desyrel were nearly twice as likely to have an accident.
- Ambian users appeared to have the greatest risk, at more than twice the rate seen for people who didn’t take sleeping pills.
This and other studies resulted in the USA Food and Drug Administration issuing guidance to reduce the amount of active ingredients in sleeping pills, especially those prescribed for women:
Doses should be reduced from 10 milligrams to 5 milligrams for regular products, and 12.5 milligrams to 6.25 milligrams for extended-release pills.
Dr. Ellis Unger, from the FDA’s Office of Drug Evaluation said:
Patients who must drive in the morning or perform some other activity requiring full alertness should talk to their health care professional about whether their sleep medicine is appropriate.
Research into dosage levels
Despite some of the alarming research, I suspect many readers will still be willing to take sleeping pills because the benefits will be seen to outweigh the risks.
In that case you might also be interested in some more recent research which might make you think about at least reducing the dosage levels.
In 2015, researchers from the Perelman School of Medicine at the University of Pennsylvania undertook a study to compare the effects of intermittent usage of sleeping pills zolpidem (Ambien) against those who used them every day.
The study split 74 adults with severe insomnia into 3 groups and monitored them over 12 weeks:
- Group A took a sleeping pill every night.
- Group B took a sleeping tablet 3-5 times a week.
- Group C took nightly pills, but half the pills were placebos.
The results were very interesting. All three strategies were effective in helping people to sleep. However the intermittent Group B subjects reported more problems in sleeping and medical issues than the other two groups.
Group C, who took a pill every night, but only half of them were actual sleeping pills, appeared to sleep just as well as Group A, who took a sleeping pill every night.
One of their conclusions was:
When it comes to day-to-day quality of therapeutic outcomes, the strategy we use most frequently, the intermittent doing strategy performed worst…Our findings also go against the standard practice of ‘start low and go slow,’ in favor of a ‘start high and go low’ dosing strategy in which a patient starts with 10 mg nightly and then when the desired result is reached, switch to either a lower nightly dose or intermittent dosing with placebos on non-medication nights.
I think we may well hear more about new dosage and frequency approaches to taking sleeping aids over the next few years.
What’s worse – no sleep or taking sleeping pills?
If given the choice, most people would probably prefer not to rely on sleeping pills if something else worked. And as you can see, there can be serious consequences to the regular usage of sleep aids.
But equally if you read our article about the benefits of sleep, you’ll see that there are also significant health and other safety issues with not getting enough sleep.
So you may find yourself stuck between a rock and a hard place trying to decide between sleeplessness or sleeping pills.
So what can we learn from this?
I suspect you’ll have tried several different techniques to sleep better, either before trying sleeping pills or returning to them once again.
Personally, I’ve managed to more or less get my insomnia under control using alternative strategies, even though it hasn’t been easy. And I have at times resorted to some over the counter sleep aids to help me through difficult patches.
I think it’s a personal choice at the end of the day. If you have the time and patience to try out alternative methods to tackle insomnia, it can only be a good thing.
If you do decide to go down the sleeping pill route, then I would recommend remembering the advice in this article to keep it to as short a period of time as possible. And during that time perhaps prepare yourself to sleep without them, using natural techniques.
What would I suggest?
If you haven’t already, then you might want to talk to a doctor or medical professional about your sleep problems.
Understandably, in some countries like the United States this may not be an option you want to follow due to the cost. But you have to weigh up the risk of leaving a potentially serious underlying health condition untreated.
Because of the risks, I would be cautious about using over the counter sleeping drugs or drugs bought on the internet without first seeking advice from a medical practitioner or pharmacist.
Many doctors will also encourage patients to go down the self-help route, by adhering to what’s called good sleep hygiene.
This is all about making lifestyle choices and developing routines which will promote healthy sleep. It can be extremely effective if you stick to it properly over time.
You might also be interested in reading the article about mindfulness. It includes a section on Cognitive Behavioral Therapy, and some researchers are now saying that CBT can be as, if not more, effective than prescription drugs.
And you could even try some herbal or natural remedies first. Whilst the evidence is still conflicting about how useful they can actually be, many people still swear by them.
If you do take sleeping pills, then you’d probably want to ensure you understand the health risks and be careful not to become dependent on them.
Use them sparingly when you have a really bad episode of insomnia, and stop taking them as soon as possible.
Sometimes just taking one pill for one night can be enough to reset a better sleep pattern.
The question of whether to take sleeping pills or not can be very emotive. Some people do think researchers over-emphasize the negatives and that the expert advice doesn’t balance the risk with the massive impact that insomnia can have.
I’d be very interested to hear about your experience. For example, have you managed to reduce your reliance on sleeping pills and if so, how?
Or perhaps you’ve tried everything and sleeping pills are the only thing which work for you.
Please feel free to leave a comment below with your views about the pros and cons of taking sleeping pills.