Episode 25

Sedatives

Have you heard about the latest best drug developed that will make you fall asleep fast, stay asleep all night, and wake up feeling refreshed the next day? No? Probably because it has never existed.

In this episode, I review the topic of “sleep drugs” and the fantasy of getting a good night’s rest from a pill. 

In addition to alcohol as discussed in Episode 15, there are several pills people will try in an effort to fall asleep. Over the counter substances are unregulated, with studies demonstrating widely differing purity levels and even ingredients compared to what's on the label. Melatonin is a clock hormone, not a sleeping drug, and studies consistently demonstrate it does not help insomnia. Most other OTC offerings include sedating antihistamines. These substances have been shown not only to not help with sleep, but distort natural sleep by sucking out quality sleep, increase overall arousals, in addition to increasing the risk for dementia by over 30%. 

Prescription drugs don't fare much better. The most commonly prescribed drug for sleep is off-label; the evidence suggests that contrary to prescribers hopes, sleep quality is significantly worse objectively and subjectively. For a medication to be approved by the FDA for a medical condition, pharmaceutical companies run a series of clinical trials to demonstrate the merits (and potential risks) of the medication. While there are very strict rules and regulations to follow in clinical trials, when the salesman who stands to make a profit from selling a product is the one "proving" that it works, potential bias cannot be ignored. That being said, the data on FDA-approved sleeping pills is pathetic. 

When individuals take some of the newly-approved medications, they fall asleep not even 2.5 minutes faster than placebo. That is incredibly unimpressive. Even frequently used agents like zolpidem (sold under brand name Ambien) only work 5-12 faster than taking nothing. And once the user does fall asleep, the rest of the night is far worse than when taking nothing at all. Sleep stages are disrupted, quality sleep is dropped in favor of light unrestorative sleep, plus a next day hangover. 

Immediate next day effects of this kind of disrupted sleep from sleeping pills dramatically increases motor vehicle crashes and MVC fatalities. Next day thinking is significantly worse. But it is the long term effects of these agents that is the most concerning. Use of these "sleeping pills," for as little as one week in the case of zolpidem, significantly increase the risk of developing Alzheimer's dementia. The longer the use, the greater the risk. Among those suffering cognitive impairment, risk for death increases by 40% from use of these agents. 

There are a multitude of other short and long term risks associated with these pills. But it comes down to this: are you willing to risk all of that just to fall asleep a couple minutes sooner but still have the rest of the night ruined?

Compared to medications in head to head trials, non-drug therapy always wins out: it is more effective, does not distort and ruin quality of sleep obtained, has sustained benefits long after the intervention completed, and has no deadly side effects.