Do they work? How long should you take them for? Can they cause addiction? Jo Macfarlane asks the experts everything you need to know…
Hours of tossing and turning. Lying awake, night after night. Insomnia is a killer – literally. It has been linked to high blood pressure, diabetes, heart attacks and strokes.
Yet one of the simplest remedies is also the most controversial. Sleeping pills, taken by 2.4 million people in the UK, have been linked to addiction, overdose, daytime grogginess and even a greater risk of death compared to those who don’t use them. Many doctors believe they’re a last resort, and should be used only for limited periods.
But while they are not a cure for insomnia – because they don’t address the underlying cause of sleeplessness – they can help you get some much-needed rest if lack of sleep is seriously affecting your life. We asked the experts to tell us more.
Use sleeping pills sparingly
Medication is a means to an end – not an end in itself, according to Dr Irshaad Ebrahim, consultant neuropsychiatrist and medical director of The London Sleep Centre. But if lack of sleep is impacting on your quality of life, sleeping pills can, in the short term, help you get the rest you need to deal with the underlying cause more effectively. For chronic insomnia, they should be taken alongside therapy such as cognitive behavioural therapy (CBT). Dr Hugh Selsick, consultant in psychiatry and sleep medicine and spokesman for the British Association for Psychopharmacology, says: ‘CBT has the best evidence base of any treatment and, unlike sleeping pills, it can cure insomnia.
‘If someone isn’t sleeping because they have a big exam or they’re stressed or there’s been a bereavement or they have depression, we’ll be more inclined to give them sleeping pills as it’s likely to be short term and needs treating quickly. But for chronic insomnia, you also need CBT.’
Dr Ebrahim adds: ‘If someone is very distressed about their lack of sleep, it’s unlikely they’ll engage in a therapy programme. So it’s better to give them a prescription first and get them to a stage where they can engage.’
Not everyone can take them
Someone with a history of addiction may not be suitable, and they are only given as a last resort to pregnant women, in cases where not prescribing them might cause greater harm.
Doctors are also reluctant to recommend them to people in the sole care of young children, in case the drugs have such a sedative effect that they are unable to look after them.
If you also have sleep-related breathing problems such as sleep apnoea, a lung disease or severe kidney or liver problems, you may be advised not to take them.
Can you get addicted?
It’s the nagging question which puts people off sleeping pills. Dr Selsick says data shows they ‘aren’t particularly addictive’. But you still need to be careful.
‘There are people who do become addicted to them,’ he says. ‘But it doesn’t mean they’re a highly addictive medication.’ The first sleeping pills, barbiturates, were extremely addictive, but are no longer used. The latest drugs, benzodiazepines or so-called “z” drugs such as zolpidem and zopiclone, increase the amount of a chemical messenger in the brain called gamma-aminobutyric acid. This gives a feeling of calm and drowsiness.
‘They were launched with this fanfare of being nonaddictive,’ says Dr Ebrahim. ‘But you need to look at the individual to see whether they, personally, are likely to develop an addiction.’
Some anti-anxiety or antidepressant medications, such as trazodone, also work without being addictive. But watch out: signs of addiction include constantly escalating the dose and taking the drugs outside normal sleep times.
‘The difficulty comes if you don’t treat the underlying sleep problem,’ says Dr Selsick. ‘Pills aren’t a cure. Insomnia will still be there when patients stop taking them, and then they’ll want more.’
You might feel groggy
Particularly when you first start taking them. It can feel like a hangover, with brain fog, dizziness and light-headedness. This usually passes quickly and won’t last all day. Alcohol can make it worse, so don’t drink. And never drive until you feel better.
Some drugs are shorter-acting and designed to get you to sleep, rather than stay asleep, so may be better for those who struggle with morning grogginess. Your GP can also adjust your dose if you’re having problems.
They can help with a ‘reset’
After a rough week at work, or stress before a big exam, a short course – around three days – of sleeping pills is fine. Those working shifts can use them to switch between working days and nights. But for jetlag, while sleeping pills can help you catch up on your kip, you’ll still be tired once you wake because your whole body clock is out of whack. Dr Ebrahim recommends instead a short course of melatonin – a synthetic version of the body’s sleep hormone – to help reset normal rhythms.
They’re only on prescription
Sleeping pills such as benzodiazepines and other drugs used as sleep aids – ‘z’ drugs, melatonin, anti-anxiety medication – are only available in the UK on prescription. Other herbal-based remedies can be bought at health-food shops or over the counter at pharmacies.
Herbal remedies are an option
There is some evidence from good quality clinical trials that some herbal remedies can improve sleep. Saffron extract, passionflower and ashwagandha root have all been studied. ‘The effects weren’t huge, but there were no increased adverse reactions,’ says Dr Selsick. ‘So they’re worth trying.’ Also available in pharmacies and health-food shops are supplements such as valerian (aka ‘nature’s Valium’) and magnesium, which is an essential mineral for health. A magnesium deficiency is thought to cause restless sleep.
Another product called 5-hydroxytryptophan, or 5 HTP, naturally occurs in the body and is thought to boost levels of serotonin, the ‘happy hormone’. By doing so, it may offer additional benefits as a sleep aid.
The trouble with herbal products, Dr Selsick explains, is that there is no ‘quality control’ or standardisation in terms of their strength or ingredients. ‘Getting the same effect demonstrated by a well-designed trial is difficult,’ he said. ‘Herbal extracts by nature vary – even where they’re grown and the weather as they were growing can affect potency. This is an area being investigated, but the general feeling is that there isn’t enough evidence to say whether they help, although they don’t seem to harm.’
Always talk to your GP if you are considering taking herbal supplements alongside sleeping tablets, as they can increase drowsiness.