Sleeping pills pose risks but so does misery of insomnia

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The woman in my clinic was desperate. I’d seen her a number of times since the birth of her child, who didn’t sleep for more than a couple of hours in her first few months. 

Now her toddler, aged two, slept at night. But the same wasn’t true of mum. My patient was in tears and begged me for help, and anyone who has suffered long-term insomnia will relate to her distress.

The National Institute for Health and Clinical Excellence, which provides guidelines for doctors, says I should first advise her to make sure her bedroom isn’t too warm or cold, too light, or noisy, and that she shouldn’t do anything but sleep there.

Night, night: Although the first port of call is diet and exercise, a sleeping pill does not have to mean addiction

It also says regular exercise is key, but she’s tried these approaches. The first-line treatment should be talking therapies. But there are so few NHS therapists that waiting lists in my area are nine months long.

So I am able to offer only a sleeping pill. The hope is   week-long course will help get her back into a routine. But she may join the growing numbers of NHS patients taking tablets long-term.

 

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Aren’t you just making the problem worse by dishing out sleeping pills?

 I see a case like the one above at least once a week – triggers can be anything from a new baby to bereavement or the stress of moving house. 

Worthwhile: Benefit of sleeping pill is bigger than risk

One per cent of patients in my practice are on a repeat prescription for sleeping tablets. The British Medical Association has revealed that 18 million sleeping pill prescriptions were written last year and public health ‘experts’ have made all kinds of bluster about patients whose ‘lives have been blighted by dependency’.

The situation is made no better by sensationalised stories about stars such as singer Sarah Harding  of Girls Aloud – a self-confessed alcoholic – who claims she was addicted to sleeping pills. In reality, taking these tablets isn’t the ‘nightmare’ it is often reported to be. It’s like any long-term medication, with risks and benefits.

GPs come in for hefty criticism when we’re stuck between the rock of insomnia and a hard place where the only help we can offer leads to dependency. In many cases, tablets are far better than the misery of insomnia: sleep deprivation is a form of torture.

Don’t sleeping pills turn people into zombies?

Certain sleeping tablets do give rise to a hangover, but these are rarely prescribed now. The newer drugs do not leave people sedated. The vast majority of those on tablets long-term lead perfectly functional lives. It’s  not ideal to be dependent on a prescription, and concerns have been raised over driving safety. But the risk versus the benefit means this is a worthwhile option.

Short-term solution: Sleeping pills should not be used for longer than necessary

Do sleeping pills actually work?

They work for short-term insomnia, but we know there is a placebo effect. Simply knowing they are taking something helps patients relax and drop off. In a recent study, subjects taking a dummy pill took only 20 minutes longer to fall asleep than those taking a sleeping tablet.

What happens if I become addicted?

In the past few decades patients were made into sleeping-tablet addicts by free-flowing prescriptions. Nowadays we are more cautious, but we still don’t have the best tools available to avoid this. Courses of sleeping tablets should not last longer than two weeks. The hope is you’ll not be on medication for long. Patients ready to come off tablets are helped by their GP. Benzodiazepines such as temazepam affect the chemical balance of the brain, meaning that coming off them suddenly can  cause symptoms similar to illness  or rebound insomnia.

Will I have to take more tablets as my body gets used to them, increasing the risks?

This is a myth. Patients on tablets long-term stay on the same dose. If you find they no longer work, then an underlying cause must be explored by your doctor: for example, thyroid disease, the menopause or depression.

If I don’t want to take pills, what else is there?

Other than treating underlying problems that may affect sleep, relaxation therapy, sleep restriction therapy and cognitive behaviour therapy are all suggested by the NHS. In  reality, these services are  not widely available.

What about alternative remedies?

I have patients who use hypnotherapy and acupuncture. As GPs have little to offer sleep-deprived patients, it would be unreasonable to condemn patients for trying alternatives.

Read more: http://www.dailymail.co.uk/health/article-2265043/Sleeping-pills-pose-risks-does-misery-insomnia.html#ixzz2IdZqyRWG 
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