Sleep Medication

According to the Center for Disease Control and Prevention, fifty to seventy million Americans suffer from sleep disorders, and about four percent of these Americans take prescription medication to combat their sleeplessness. While four percent does not seem like a large number, this value equates to about 2 to 2.8 million Americans who are taking sleep medication. With the large number of consumers, the types of sleep medications on the market are now on the rise, making it important to know which type to take, as well as to know the cautions and dangers that come along with taking sleep medication. 

The older form of sleep medication is a form of benzodiazepines, which is generally taken by those with anxiety disorders. Benzodiazepines act on the central nervous system-- in particular, on the inhibitory gamma-aminobutyric acid-A (GABA-A) receptors in the brain, reducing the activity of neurons that induce stress and anxiety by opening chloride channels. Types of benzodiazepines that are used to fight insomnia include temazepam (Restoril), triazolam (Halcion), quazepam (Doral), estazolam, and flurazepam, all of which are approved by the U.S. Food and Drug Administration (FDA) as hypnotics. Although these five are all benzodiazepines, they differ slightly in terms of their usages and side effects, another reason as to why it is essential to have the right medication.

Temazepam is used to treat initial and middle insomnia, as it has an intermediate rate of absorption and duration of action. Since there is no active metabolite, the grogginess and cognitive impairment that may appear as side effects of other types of sleep medication are reduced. Temazepam works by enhancing the inhibitory effects of the GABA receptors, leading to stronger hyperpolarization and stabilization of the neuron. Triazolam is usually used as a short-term adjunct to behavioral therapy, but a downside is that it does not assist with sleep maintenance. While it facilitates the process of falling asleep, it does not maintain the duration of sleep, making it a mismatch for those with chronic symptoms of insomnia. However, quazepam provides a better alternative when looking for a medication that will help with sleep maintenance. Estazolam is also helpful for maintaining a long duration of sleep, but has a slow onset of action. Lastly, flurazepam is a sedative that can be used for short-term treatment of insomnia. 

However, long term use of benzodiazepines can lead to dependence and withdrawal symptoms such as depression, sweating, and difficulty sleeping. Despite this, it does not mean that one should completely cut off benzodiazepines, as this also has severe side effects such as tremors, muscle cramps, and life-threatening seizures. Instead, one should obtain professional help if planning to remove benzodiazepines from their daily lives. Other dangers of benzodiazepines is that they should not be combined with alcohol or other types of medications, such as barbiturates, opioids, and tricyclic antidepressants. A combination of medication can lead to a dangerous buildup of medication in the body, worsening the side effects of benzodiazepines, which include drowsiness, confusion, dizziness, trembling, impaired coordination, grogginess, headaches, and vision problems. Common signs of improper benzodiazepine use include slurred speech, impaired balance, and improper movement control. 

Non-benzodiazepines are the newer type of sleep medication, and they have lower risk of abuse and dependence than benzodiazepines. They are generally considered safer to take as they have less severe side effects, but this should be taken with a grain of salt, as all medication should be taken carefully and properly.  One type is zolpidem (Ambien, Edluar, Intermezzo), a sedative that helps with falling asleep but not maintaining sleep. Since some face difficulty in maintaining sleep, Ambien CR has been produced for this, but it stays in the body for a long period of time. Because of this, the FDA recommends that one should not take Ambien CR if there are no plans to sleep at least seven to eight hours that night, or to drive or perform activities that require activeness and alertness the next day. Zolpidem can impair thinking and reactions, and one may still feel sleepy the next morning. It is recommended that there should be a four hour gap in between waking up and performing an activity that requires alertness. Since some people have reported to take zolpidem but not remember activities performed (i.e. driving, eating, making phone calls) , the FDA reduced the recommended dose in 2013. Another caution is that zolpidem contains lactose, so those intolerant to lactose should be careful when selecting medication. 

Whether the medication is a benzodiazepine or not, they should all be taken carefully, as there are a variety of side effects that can result from overdosing or improper usage. For example, a study has shown that some patients find that taking zolpidem is not as effective as they expected, and may take more than the recommended dose in attempts to sleep more easily. This has shown to be a common problem among those taking sleep medication, in which they find that one sort of medication is not working as well as they expected, and instead of looking for other alternatives, they resort to overdosing. Another problem is that some patients do not realize the dangers of taking sleep medication with alcohol and other types of medications, and therefore do not report to their physician if they are taking other types of medications. In a study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of visits to the ER caused by zolpidem overdose or mixing it with alcohol or other types of medication nearly doubled from 2005-2006 (about 22,000) to 2009-2010 (about 42,000). This makes it a serious issue that needs consideration when taking medication, especially sleep medication. Although the idea of falling asleep easily or being able to maintain sleep through medication sounds prospective and tempting, it is also essential to take the correct type of medication while considering one’s situation and medical history, as well as keeping in mind the proper dosage and usage. 

References:

https://www.webmd.com/sleep-disorders/insomnia-medications 

https://www.ncbi.nlm.nih.gov/books/NBK19961/

https://www.livescience.com/39278-americans-use-prescription-sleeping-pills.html

https://www.rxlist.com/benzodiazepines/drug-class.htm

https://pronghornpsych.com/how-do-benzodiazepines-affect-the-brain/

https://medlineplus.gov/druginfo/meds/a684003.html

https://www.spine-health.com/wellness/sleep/non-benzodiazepine-sleep-aids