Sleeping Pills & Other Sleeping Aids What sleeping aids do you recommend? What are the benefits or side-effects with such sleeping aids? Non-addictive sleeping aids are safer for use than true “sleeping pills” which carry the risk of tolerance and dependence (or, addiction). Such sleeping aids are usually in the antihistamine or antidepressant class, and can be effective in relatively low doses. Such non-addictive sleeping aids, and potentially addictive sleeping pills in selected cases, can only be prescribed by doctors, after a consideration of the patient’s medical background. Sleeping pills should not be routinely used in the long term because of the risk of tolerance (when gradually increasing doses are needed over time) and dependence (becoming addicted to sleeping pills means being unable to sleep without the sleeping pills). How does addiction to sleeping pills develop, and what are the consequences (both long-term and short-term) of such addiction? Sleeping pills addiction occurs after repeated, often daily use, during which the patient develops “tolerance” which means that the body gets “used” to the original dose of drug, which then over time is no longer effective. The patient then has to use higher and higher doses of the same medication to achieve the same effect. After some time, the patient becomes dependent on the sleeping pills and cannot sleep without them. This is known as sleeping pill addiction or dependence. The harm of this is that the sleeping pills cloud mental functioning in the daytime, and increase risk of respiratory suppression (ie. make breathing difficult because the muscle of breathing are too relaxed) as well as falling (because sleeping pills may make one groggy and have poor coordination, so one may fall as a result of being off-balance), especially in the elderly. If the sleeping pills are stopped suddenly, patients may develop a severe rebound insomnia, or even get drug withdrawal seizures (“fits”). In general addiction to any substance has significant negative health impact because typically, the true underlying cause of the problem is masked by the drugs, and the patient does not make the necessary behavioural and lifestyle changes actually needed to get better. How can a person wean himself off sleeping pills if he is already addicted to them? This is a challenging task which usually requires the supervision of a trained specialist. The process involves diagnosing the original problem which led to the insomnia, instituting proper treatment for the actual cause of the problem, and gradually reducing the dose of the sleeping pill once alternative measures are in place (such as replacing the sleeping pill with other, non-addictive drugs which can help the actual underlying problem – such as antidepressants for depression, psychological techniques to help behavioural changes etc). Educating the patient on the dangers of sleeping pill addiction, and the appropriate use of such drugs, are important as well. Can long-term use (more than 3-5 years) of prescription sleeping medication cause memory problems or result in cognitive impairment? Yes, long term use of sedative-hypnotic medication can result in cognitive impairment, and may affect memory and thinking ability. What other treatments are there available for patients suffering from insomnia, other than sleeping pills? The treatment for insomnia – which is a symptom and not a diagnosis – depends on the cause. The most common causes are psychologically based, ie. stress, depression or anxiety. Other causes include physical problems like sleep apnoea, or restless legs syndrome. Whatever the cause, accurate diagnosis and treating specifically the actual underlying problem are key. Medication can be helpful, though behavioural changes are the most healthy and natural long term measure. Anxious and depressed patients can improve with a course of antidepressants. Psychological intervention is also helpful. Depressed patients, for example can benefit from “talk therapy” during which they are given the opportunity to ventilate about their concerns, and taught positive ways of looking at things. “Cognitive-Behavioural Therapy (CBT)” is a well-established psychological method which is helpful for certain types of insomnia. CBT usually takes the form of several weekly sessions during which patients are taught about good sleep promoting habits, natural relaxation techniques (eg. progressive muscle relaxation, visual imagery) and their misperceptions about sleep addressed and corrected. Can melatonin supplements help with insomnia? Melatonin is a natural sleep hormone which can be taken as a supplement and obtained without prescription. It has very modest sleep inducing benefits when taken in this way in general. However in older people who have low natural melatonin levels, melatonin can be effective as a sleep aid. Also, in people who have circadian rhythm disorders (ie. sleep disturbances which are related to our biological “body clock” being out-of-synch with the external environment) such as jet lag, and shift work related sleep disturbances, melatonin can also be useful to help induce sleep. Melatonin may cause blood vessels to constrict, so should be avoided in people who may have narrowed blood vessels, such as coronary artery disease. Aside from natural remedies, what sleep aids do you recommend? Learn a natural relaxation technique, such as progressive muscle relaxation, or visual imagery. Anything which helps us wind-down, in the form of a regular bedtime routine about an hour before sleep, can be helpful. A bedtime routine may include reading, listening to music, prayer – any activity which can be done in a restful, quiet and relatively dark (vs the bright lights of a computer, TV screen) environment is conducive to sleep. Melatonin is the body’s natural sleep “hormone” – melatonin supplements can be given to some types of patients as a “natural” sleep aid (eg those in the older age group who do not have heart disease, shift workers, those suffering from jet lag).