We have all had a bad night sleep. Most of us either wake up grumpy, short tempered, or extremely exhausted. Our bodies feel it, and we reach to our favorite liquid stimulant – coffee. For some of us, one bad night of sleep leads to another and before you know it, acute insomnia. These bad nights start to affect your daytime performance, and before you know it, chronic insomnia. Thus leading to Sleeping Pills.

If you listen to all the popular health trends, you know now that sleep has become the focus of longevity and vibrant heath. The benefits of sleep can range from waking up with energy to preventing diabetes, heart disease, and cancer. Getting healthy natural deep quality sleep can help jump start any health journey. We have seen this with chronically ill patients suffering from sleep apnea. Once they are able to breath correctly, they are able to sleep naturally. Their health improves dramatically and they become a different person. There is no wonder why drug manufacturers are pushing the latest and greatest sleep solution; sleeping pills.

Like many others, we will head to our regular doctor, and tell them about an option that you heard of on television or from a friend. If you are lucky, you doctor may recommend changes in your sleep like sleep hygiene tips and to seek a behavioral consultant. Given that we live in a society that seems to have a medication for every symptom, you will most likely get your sleeping aid.  And if you find yourself taking that medication every night, you will also notice that the effects will eventually wear off or lessen over time. Before you know it you need a stronger dose, a stronger sedative, and you can’t sleep without it!

Did you know, the majority of sleep medication state in there FDA labeling that you should not use these medications more than 6 months. So, why are sleeping pills dangerous?

DAngerous sleeping pills

At the top of the list of dangerous sleeping pills, you have:

  • Barbituates (Phenobarbital, pentobarbital, primidone), not very common
  • Benzodiazepines (Temazepam, Clonazepam, Lorazepam, Diazepam, or Alprazolam)
  • Z hypnotics (Zolpidem, Zeleplon, or eszopiclone)

These medications are known for their dangerous depressing effects on the central nervous system (CNS). Sedation is one key problem, but these medications are notorious for interacting with other CNS depressing agents like common pain medication, certain cough medications (containing Dextromethorphan, nerve medications (Gabapentin or Lyrica), and alcohol. The interaction with the CNS agents above have led to countess hospital visits due toxicity, respiratory depression, or death.

[Sleeping pill treatment was associated with much more risk than reported insomnia. Important limitations of the CPSII analyses included lack of definition of the particular prescription sleeping pills utilized and lack of consideration of the extent that participants maintained their prospectively reported use (or lack of use) of sleeping pills throughout the 6-year follow-up.]

On a more general scale, these sleeping pills whether they be the one listed above (Barbituates, Benzodiazepines, or Z hypnotics) or antihistamine (Benadryl) seems to shut down brain activity (1). This could explain a lot of the longer term side effects with the body’s immune system that I will talk about further later in the article.

Briefly, let’s look into some of the most common sleeping pills. Based on this article, I will not be diving into off label uses of medications for sleep such as anti-epileptic (Gabapentin), antidepressant (trazodone or Mirtazapine), or antipsychotic medication (Quetiapine or Olanzapine) used for sleep. Although these are common medications that are used for treating other conditions while eliciting a sedating effect, please leave a comment below if you have questions about any other medications that I do not talk about here. The sleeping pills listed below are some of the most commonly used medications that are prescribed for insomnia. We will start with the Benzodiazepines.

Based on meta-analysis from Dr. Daniel Kripke on medication used for sleep, he was not able to identify any clear epidemiology studies of mortality risk on Trazodone, doxepin (especially low dose), and melatonin when used as a hypnotic.

What do Benzodiazepines do?

Temazepam (Restoril®) is the most common medication in this class. However, Alprazolam, Clonazepam, Diazepam, and Lorazepam have made their way into the category for sleep with their popular sedative effects. It’s important to understand the nature of these medications and why they are not ideal for sleep. Not only do Benzodiazepines work as hypnotic medication (sedating you or making you feel drowsy), but they have also been used in anxiety relief, muscle strain, and for seizures. Proving to be a very powerful brain and whole body sedative. None in which have been proven to guaranty natural and deep quality sleep.

These medications can be dangerous due to their prevalent interactions with common medications like pain medications, muscle relaxers and alcohol. People have reported events like amnesia or significant hangover-like effects the next morning. If this wasn’t enough, the elderly population is in grave danger while taking these medications. Consequently, the elderly are at risk for increased drowsiness, dizziness, and have a higher risk of major falls. As a result, falls in the elderly can lead to serious bone fractures that can significantly decrease the quality of life, increase mortality and worsen other comorbidities.

Common Benzodiazepines used for sleep are

  • Temazepam (Restoril®) is the most common medication in this class that is used for sleep.
  • Alprazolam, Clonazepam, Diazepam, and Lorazepam have made their way into the category for sleep with their popular sedative effects.

In addition, Benzodiazepines also interfere with common conditions like Asthma and COPD. These medications can decrease the respiration ability, and worsen any chronic lung condition. Doctors have witnessed accidental overdose with patients taking Benzodiazepines with COPD or Asthma. Combining this interaction with a common cold or flu, and you have a very serious lung condition that can lead to hospitalization.

For many of us, there are certain medications like Diazepam and Flurazepam that are metabolized and those metabolites remain active on the GABA A Receptor causing these sedative effects. If that’s not bad enough, these metabolites accumulate over time as you continue to use these medications daily. Of course, everyone’s metabolism is different and your body might metabolize different than others. With that said, another popular medication of choice Chlordiazepoxide can stay in your body for weeks causing this type of sedation and potential for overdose more likely.

About Metabolism: Side note and slight tangent, but important.

Our body has a unique and complex feature that is  operated by the liver. The liver produces these enzymes that we abbreviate and call them Cytochrome P450 enzymes that will interact and change these drug structures to either an inactive component or another active component that can wreak havoc on areas of the body. This is why having a drug specialist a part of your team is paramount. However, just because you have these metabolic enzymes that break down these chemicals does not mean they will work perfectly when you need them to. Several things can affect your drug metabolism and here are a couple of things you should think about.

  • Genetic components: Different people have a genetic component that allows them to make these metabolic enzymes that rev up certain medications. Have you ever me someone that had to take higher doses of certain medication than everyone else before they had the desired effect. I had a friend that needed a higher dose of alcohol than myself, and I would consider him a light weight like me!
  • Liver workload: Your body gets preoccupied when you give it other things to do. For instance, if you are taking any other medication that can suck up your resources in general, you will notice a slowdown in drug metabolism. Therefore, being on other chronic medications in general, you want to avoid being on any other medication that can cause a sedation effect or any other disastrous effect.
  • Nutrient deficiencies: It should be obvious, but we rarely think about the nutritional component that is involved to fuel this important process. In general, eating a healthy diet with a variety of different vegetables of all sorts of colors can boost your metabolism. Especially your cruciferous vegetables like broccoli, kale, cauliflower, or Brussel sprouts. For example, when your body detoxifies alcohol, your body uses us resources like magnesium, Vitamin B1 (thiamine), Vitamin C, and Coenzyme Q10.  So, if you are worried about a big night of drinking, you could support this process with a great multivitamin and these supplements plus Sesamin and N-acetylcysteine (NAC) to help with the headache, nausea, thirst, and light sensitivity.
  • Exercise or Sweating: As you can imagine, the ability to move and allow blood to flow can help push out metabolites by cleaning out the Lymphatic system and allowing for more blood to flow through the liver and allow the medication to metabolize and get filtered out through kidneys. In addition, sweating from exercise or a sauna can help push out toxins and certain metabolites. Just remember, that it is very important to take a shower afterwards and possibly use a skin brush to rid yourself of any toxic chemicals.
  • Water intake: So Important! You can not stay healthy and active if you do not drink water. Your organs need water to continue to work optimally. It helps to replenish lost fluid and helps to keep the body operating optimally.

Z Hypnotics

This drug class is probably the most popular sleep drug class since the Benzodiazepines. At one point, they were heavily advertised as being the safer option over other sleep medication. These were common brands like Ambien ® (Zolpidem), Sonata ® (Zaleplon), and Lunesta® (Eszopiclone). Within years, these medication became the top prescribed sleeping medications over all other drug classes. Matter of fact, the generics of these medications are still heavily used today.

Why were these preferred over Benzodiazepines? Well, as of now, there is no clinical guideline that recommends Z-hypnotics as the safer drug. Matter of fact, trained doctors that are experienced in taking  patients off of these dangerous sleep medication typically avoid Z-hypnotics. Mainly because Z-hypnotics still contain the dangerous side effect of hypnosis. Even though they have less effects in treating seizures and anxiety, the main effects of drowsiness and sedation are can be extremely dangerous for anyone with kidney or liver issues, the elderly, and anyone taking more than 2 other medications at the same time (because of the interactions between medications).

Side effects and drug interactions are very similar to the Benzodiazepine class. They also carry the same risk in the elderly population with increased falls and major bone fractures. However, one of the most common and most dangerous side effect from this class is its ability to put you in a hypnotic state. How can this hypnotic state be dangerous you might ask? If you recall the multiple news stories and articles about people “Sleep driving,” “Sleep cooking,” “having sleep sex,” or “sleep walking outside their house.” Then let me enlighten you with a story.

https://www.cnn.com/travel/article/planes-sleeping-pills/index.html

A man traveling on airplane from London to San Francisco decided to take Zolpidem 10 mg (Z-hypnotic). He thought he had slept and had funny dreams of people on the plane. And then when he awoke, he saw all the crazy photos on his phone of himself and other passengers on the plane. He had found himself in a situation where he was in a light state of sleep and easily aroused by the environmental stimuli. Needless to say, he was very lucky that he did not experience anything inappropriate while on the flight.

Antihistamines (Benadryl® or ZzzQuil®)

How harmless can you get when you talk about medications or supplements that you can buy over-the-counter (without a prescription). Well, for starters, the active ingredient in Benadryl (diphenhydramine) as well as many other cheap allergy medications are extremely dangerous for the elderly. This class is known as first generation antihistamines, and they include common brands like Dramamine® (Dimenhydrinate), Vicks NyQuil® (Doxylamine), and Dimetapp Cold® (Brompheniramine). They are typically known as potent antihistamines that can easily dry up your runny nose, but can also lead to a whirlwind of unwanted side effects for the elderly. Side effects like extreme dry mouth, urine retention, constipation, elevated blood pressure or dizziness or sedation.

People using antihistamines for sleep have been shown to have less Deep Stage sleep and REM sleep thus waking up more drowsy and sedated the next morning. This side effect is one that I must tell patients about when I see them buy this over the counter for sleep. As we age, our kidneys slow down in filtering out all the metabolites of these medications. As you can imagine, these medication can stay in our bodies a lot longer and cause a more potent effect than we are typically used too.

Antihistamines can work like other Sleeping Pills

In a study, Saras et al found that antihistamine drugs not only blocked the Histamine 1 Receptors in the brain to cause sedation, but they also trigger sedation through the same receptors that Benzodiazepines and Z hypnotics which are the GABA a Receptors. This causes the brain activity to basically shut down and stop working as effectively. The reason why this is so important is because the brain helps to trigger a lot of the bodies ability to recover in Deep Stage REM sleep and REM sleep. Without the brain to signal these natural pathways, you find that you don’t feel as rested in the morning or little groggy.

In addition to that, there are many medications on the market that exhibit the same effects as these 1st generation antihistamine. Without going into too much detail, here are examples of those medications that cause drowsiness and they may or may not cause effects on the GABA Rc which seems to be the huge issue of mortality.

Antidepressants

  • Amitriptyline
  • Nortriptyline
  • Mirtazepine
  • Trazodone

Antipsychotics

  • Quetiapine
  • Olanzapine

 Other medication that have the same effect as Benadryl

  • Hydroxyzine
  •  Promethazine
  • Cyproheptadine

Just because these medication are not used for allergy relief, does not make them safer or a better alternative to medications like Benadryl for sleep. These medications above bind to the same histamine receptor and admits the same type of reaction towards sleep. Many general doctors still recommend these medications as alternatives to Benadryl for sleep, but these medications still pose the risk. Poor quality sleep and grogginess when you wake up are some of the most common complaints about these medications.

If I’m using pills for its sedation effect, “why should I worry about it?”

The answer can be found in my in-depth article into why sleep is so important. In short, our bodies do not undergo a “passive process” when we sleep. We simply don’t shut our minds off at night and go to sleep. Our minds undergo a very dynamic and active process that is needed to communicate with the rest of our body. From regulating important hormones like Growth Hormone and Insulin to revving up your immune system to fight off potential infection. Your brain is at the center of it and it needs to undergo it’s natural way of working. Sedative sleep medication ruin this.

Believe me. There is a time and a place to use sleeping pills, but using them longer than 2 weeks is not doing any one a favor. Our brain is wired to favor the easier path, and when you give some one a simple solution like swallowing a pill. You get the attention of everyone in the room.  I wish it were that simple, but ongoing research as proven that these sleep aids not only have dangerous side effects, but also long-term side effects related to mortality and death.

So we know the side effects and downsize of sleeping pills, but how do sleeping pills cause death?

In 2015, a medical doctor from the University of California San Diego, Dr. Daniel Kripke M.D., investigated the different types of sleep medication listed above. He investigated over 200 studies looking into the harmful effects and risks of taking sleep medications. Based on the side effects that I had mentioned already, we know there are higher incidents of death related to respiratory failure, accidental deaths due to drug interactions, suicides and even homicides.  Suicides and homicides were supposedly done under the influence of the hypnotic state of sleeping pills, mainly the Benzodiazepines and Z-hypnotics.

In addition to the findings above, there were some very surprising findings that were discovered with individuals that had a history of taking sleep medication for over 6 months. Based on these studies, these individuals had higher risk of death due to cancer and serious infections. How would sleep medications compromise the immune system to allow cancer and severe infections?

Based on my recent blog, The Importance of Sleep, we know several things about sleep and the immune system.

  • We know that natural sleep can strengthen our immune system. Specifically, sleep helps to bolster the immune cells that destroy cancer cells in its early stages.
  • We also know that our brain is very active when we sleep. When monitoring our brain waves we see very specific activity in each stage of sleep. These robust brain waves help to relay messages to the rest of the body during sleep to recharge our immune cells.

Now here is a theory among leading researchers in sleep. When a sedative like a sleeping pill is taken. Does it have the ability to minimize brain wave activity and therefore affect quality of sleep? Researchers seemed to think so! Researchers have noted less time in deep sleep and REM sleep from individuals that use sedatives for sleep. They also believe this reduction in quality of sleep and brain wave activity lessens the immune response to the body. Therefore, minimizing cell repair and weakening the growth of new immune protective cells. And eventually leading to an increase chance of serious infections or eventually cancer over a long period of time.

What we know about sleep deprivation and our immune system.

Based on short sleep term sleep deprivation studies on humans and studies on mice, we have discovered so many advantages of sleep as it relates to our immune system. Here are some examples of studies that have shown this:

  • Dr. Eric Prather from the University of California San Francisco performed a sleep experiment. He quarantined 150 people and squirted a rhinovirus (common cold virus) and monitored for symptoms. He found a linear infection rate the lesser you slept.
  • In a 2002 study, researchers separated participants that slept under 5 hours and a full 7.5 hours for 6 nights. Then, the participants were given a flu shot and their immune response was measured. Participants with less than 5 hours of sleep had 50% less of an immune response than a fully rested individual.
  • Natural Killer (NK) Cells sweep the body of dangerous elements. In a study by Dr. Michael Irwin, he evaluated the concentration of these cells after one night of 4 hours of sleep. He had noticed over 70% of NK Cells were swept away compared to someone that had 8 hours of sleep.
  • Dr. David Gozal experimented in mice that were implanted with tumors cells and that were deprived of sleep. He saw the mice with less sleep had greater mutation of their cancer, and also saw more resistance in the cancer genes compared to more rested mice.

There are countless other studies showing the negative effects of sleep deprivation on our immune cells, our GUT bacteria, blood pressure, insulin resistance and mental health. Based on the research, it seems like taking sleeping pills and depriving yourself of sleep is almost the SAME.

When should I take sleeping pills?

Believe it or not, I do recommend taking sleeping pills in certain situations. For starters, if someone has undergone a Traumatic event and can not calm their minds enough to fall asleep. Along with Cognitive Behavioral Therapy, we can prescribe a sedative to help attain some sleep.

Another instance is when someone has had several days of poor sleep. As you can imagine, getting sleep from a sedative would be better than days of no sleep. However, this should not turn into a chronic habit where you take a sleeping medication every night because it’s easy or convenient.

Lastly, I sometimes recommend a sedative for jet lag. If melatonin fails to help, and you are becoming irritable during the day. Then experimenting with a small dose of a sleeping pill can help get over jet lag. However, we should aim to discontinued your sleep sedative once you are sleeping normal in your new time zone.

Some of the links below are affiliated links. This means that, at zero cost to you, we will earn an affiliate commission if you click through the link and finalize your purchase.

5 Expert Tips on Getting off Sleeping Pills

1. Learn why you need to stop your sleeping pill. If you have read all the way to this point, you have seen that many sleeping pills reduce the amount of natural sleep like deep sleep or REM sleep. These stages are extremely important for mental health and other important process in the body that must be done every night. In addition, these pills carry dangerous side effects like sleep walking, sleep eating, or even sleep driving. If this wasn’t bad enough, there has been multiple epidemiological studies that have shown an increase risk of mortality associated with severe infections and cancer. There are studies that show a trend that your body is better off with mild to moderate insomnia rather than taking these sleeping pills long term.

2. Wean yourself off slowly. There are some sleeping pills that have a wicked withdrawal effect. Initially you might feel more anxious and alert which is to be expected with medication like the benzodiazepines. If you have been on these medications for longer than 6 months, I would typically recommend slowly tapering off of them as we start to implement positive behavioral techniques to improve sleep quality and duration.

5 Expert Tips on Getting off Sleeping Pills

1. Learn why you need to stop your sleeping pill. If you have read all the way to this point, you have seen that many sleeping pills reduce the amount of natural sleep like deep sleep or REM sleep. These stages are extremely important for mental health and other important process in the body that must be done every night. In addition, these pills carry dangerous side effects like sleep walking, sleep eating, or even sleep driving. If this wasn’t bad enough, there has been multiple epidemiological studies that have shown an increase risk of mortality associated with severe infections and cancer. There are studies that show a trend that your body is better off with mild to moderate insomnia rather than taking these sleeping pills long term.

2. Wean yourself off slowly. There are some sleeping pills that have a wicked withdrawal effect. Initially you might feel more anxious and alert which is to be expected with medication like the benzodiazepines. If you have been on these medications for longer than 6 months, I would typically recommend slowly tapering off of them as we start to implement positive behavioral techniques to improve sleep quality and duration.

    1. Start improving your night time ritual. Everyone should have some form of power down time before bedtime that triggers to your mind, you are about to go to bed.⁠ If you go from watching TV in your bedroom to turning off the lights and rolling over. This will not do! Therefore you must give yourself a bedtime ritual and start at the same time every night. Your bedtime can be anywhere from 20 to 60 minutes long depending on the sleep issue, but everyone needs a bedtime ritual.
    1. Give yourself a schedule to follow every day. If you haven’t notice by now your body works with it’s biological clock. It loves routine! Matter of fact, it THRIVES on routine! We all need to set aside at least 8.5 hours for sleep every day around the same time every night. Having an alarm that alerts you when to start winding down and when to go to bed every night can help tremendously. It’s important when you wean off of your sleep medication that you keep this bedtime schedule the same and do not adjust it on the weekends. If you find yourself unfaithful to this schedule than it will ONLY add to the frustration of not sleeping without your sleeping pills.
  •  5. Make sure you are well nourished. Along with eating a diet full of organic vegetables and fruit, you also want to make sure you are able to balance out any deficiencies that could be causing your sleep to be worsen. For instance, Magnesium deficiency is a type of deficiency that a lot of my clients struggle with. Magnesium has over 300 different roles in our body. Some of those roles are important in producing melatonin for sleep. I recommend Magnesium glycinate as the form to help with my clients. The glycinate is a part of the supplement that helps to calm down the body.

Professional Help for Insomnia

  • There are many techniques and behavioral modifications that have been clinically proven to help fix sleep issues. On top of this, there is so much we can do throughout the day to help get our body ready for sleep. There are also corrections that we can do to our physiology that help support healthy sleep. 
  • For a sleep consultant, these recommendations to our clients come with experience and training, but there is no one fix for all.  We have to review your detailed questionnaire and food & beverage log to identify these potential issues. Also taking into consideration your health history, medications, and laboratory tests (optional).  I take a very detailed holistic approach to fix sleep. But fixing your sleep is only the beginning. When sleep is gained naturally, then any investment in your health like diet modifications or new workout routines becomes easier and more efficient.

 

  • To check out sleep packages and other options available to you, please visit my services!

Zeke Medina

Zeke Medina is a certified Solve your Sleep Consultant that works with teenagers and adults struggling with insomnia and other sleep issues. Zeke has over 10 years of experience in the medical field helping individuals with chronic health issues and insomnia.

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