“O sleep! O gentle sleep! Nature’s soft nurse, how have I frighted thee? That thou no more wilt weigh mine eyelids down and sleep my senses in forgetfulness?”—William Shakespeare, Henry IV, Part 2, Act 3, Scene 1
The state of worldly affairs is enough to keep anyone awake, but when our sleep is regularly disrupted, it sets off a vicious cycle of fatigue and anxiety. Luckily, there are ways out of this loop besides sleeping pills—and you likely don’t even need the mythic eight hours of sleep per night.
There are some rarely discussed factors surrounding sleep that we can use to get the rest we need without having to alter our brain chemistry with drugs.
However, this is a deadly serious area of concern, according to sleep researcher Dr. Daniel F. Kripke, a licensed physician certified by the American Board of Psychiatry and Neurology and an emeritus professor of psychiatry at the University of California–San Diego.
Kripke has been studying sleep for years, including doing research in his earlier years for pharmaceutical companies. That changed, however, as he recounted in a comprehensive guide to the dangers of sleeping pills that he released online.
Kripke wrote in his final acknowledgments at the end of the book how he stopped accepting any fees from pharmaceutical manufacturers years ago so that he could freely report what he was discovering in his research.
“I also stopped accepting fees from tort lawyers or class-action attorneys. It is important that readers understand for whom an author works. Being supported largely by public funds, I have felt responsible for explaining the research results in the public interest,” he wrote.
Common Sleep DeterrentsIt’s important to remember that lying in bed worrying won’t help. If you don’t feel sleepy, why not sit in meditation or use CBT-I to reframe the anxious thoughts you may be experiencing?
Removing caffeine and alcohol before bed is also important. Caffeine’s effects can last for up to five hours. Alcohol may help you get to sleep, but also has the tendency to wake people up mid-sleep when their blood alcohol level falls.
People who drink early may also experience difficulty initially falling asleep. Limiting alcohol intake and not drinking every night is key to making sure you're getting restful sleep regularly. Combining alcohol with sleeping pills can be very dangerous because both drugs can alter breathing, brain function, and heart rate via suppression of the central nervous system.
Cognitive Behavioral Therapy for InsomniaFew things can keep us up at night as easily as errant thinking. Negative thoughts can have wide-ranging effects on our health and well-being. To the extent that we believe and identify with our thoughts, they can be surprisingly destructive. CBT-I helps a person to question harmful thoughts and replace them with something constructive.
The researchers didn’t find evidence of any adverse effects.
While they were hesitant to compare CBT-I to sleeping medications, they did write that “observational studies suggest that hypnotics (sleeping medications) may be associated with dementia, fractures, and major injury.”
Bright Light TherapyWhether you think of yourself as a morning person or a night owl, you may have a “circadian rhythm timing disorder” in which your body clock is moving either too fast or too slow.
“Advanced sleep phase” is the term given to people whose body clock is running too fast. Common in the elderly, advanced sleep phase involves getting up and going to bed earlier than is socially normal. It may be caused by the deterioration of vision and less light intake because of cataracts, smaller pupils, glaucoma, and other causes of macular degeneration.
Advanced sleep phase can be problematic if the person finds that they fall asleep unintentionally or can’t get enough sleep because of waking too early. Bright light therapy, using an LED light box or other bright lamp, can stimulate people in the evening and help to keep them in a more normal circadian rhythm.
People whose body clock is moving too slow have a “delayed sleep phase” in which they're receiving wake/sleep signals too late. Insomnia related to a delayed sleep phase involves a person not being able to get to sleep until very late at night. This may involve spending hours in bed trying to get to sleep and then struggling to wake up at the desired time.
Delayed sleep phase is commonly associated with oversleeping and depression. Abnormal drowsiness and fatigue in the morning can result in a person being overly dependent on stimulants or being more susceptible to accidents when they're rushed to get somewhere. Associated with rebellious behavior, delayed sleep phase is more commonly experienced by young adults, although it does also affect older adults and some elderly people.
People experiencing this timing disorder can use bright light therapy to get more light early in the morning. According to Kripke, delayed sleep phase can be a stubborn condition and can require the person to expose themselves to a very bright light for one to two hours each morning.
“Arranging to receive that light may be hard to fit in with daily habits,” Kripke said.
“I usually find that people with delayed sleep phase need one of the bright fluorescent light boxes. One convenient way to get a strong dose of morning light is to use a light box (maybe a box arranged for 10,000 lux) for 30 min at breakfast time. For people who work at a desk, placing the light box on the desk and turning it on all morning might be effective, even if one cannot sit at the desk all of the time.”
Kripke said sitting near a window or just opening the curtains rarely offers enough light to treat the condition.
Mindfulness MeditationWhen we're really stressed or worried about something, it can be very difficult to sleep. Getting out of bed to sit in meditation can help resolve troubled thoughts and feelings.
What's causing the feeling? Fear? Uncertainty? Feel the feeling and allow the thoughts to pass without engaging in them. After sitting for a while, you'll either dissipate the feeling or be ready to sleep.
Only when you feel you're ready to sleep should you return to bed. Don’t worry about the number of hours you're going to get. You’ll get what you can. Relaxing is the priority. Light some incense or play some soothing music if you want.
Meditation has the power to put one in touch with a deeper aspect of oneself. In that place of peace, our worldly concerns can lighten and a sense of calm can soothe the nervous system. Meditation in and of itself can be deeply restful.
Do We Really Need 8 Hours?It may be surprising to learn that people who sleep less on average, about 6 1/2 hours per night, may actually live longer and be less depressed than people who sleep eight or more hours.
“People who sleep five or six hours may be reassured.”
Spend Less Time in Bed?Excessive worry about the fallacies surrounding sleep can cause people to force themselves to bed even when they aren’t sleepy. Whatever your bedtime is, Kripke said that “you should not go to bed if you do not feel sleepy.”
It seems like common sense when you think about it.
Sleeping Pill DangersIn “The Dark Side of Sleeping Pills,” Kripke wrote that “American Cancer Society data from over one million people showed that use of sleeping pills was associated with more deaths within six years, but insomnia by itself was not associated with any death risk.”
While this correlation doesn't prove causation, Kripke goes on to suggest that “if sleeping pills cause even a small portion of the excess deaths and cancers associated with their use, they are too dangerous to use.” He said doing large, randomized, controlled trials posed ethical challenges and would also run counter to the interests of pharmaceutical companies.
“If sleeping pill companies believed that such trials would prove that their products were safe, they would have done such controlled trials many years ago,” Kripke said.
- Zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, and Zolpimist)
- Temazepam (Restoril)
- Eszopiclone (Lunesta)
- Zaleplon (Sonata)
- Triazolam (Halcion)
- Flurazepam (Dalmane, Dalmadorm)
- Estazolam (Prosom)
- Quazepam (Doral)
- Barbiturates (especially phenobarbital)
- Antihistamines, mainly diphenhydramine
CancerShockingly, Kripke found that “those who averaged two to three sleeping pills per week or more were 35 percent more likely to develop a new cancer within an average of 2.5 years.”
“As of July 2018, there were at least 42 published studies of the mortality risks of sleeping pills," he said. "Of the 42 studies which reported either greater or lesser mortality associated with sleeping pills, 40 studies showed that people taking sleeping pills died sooner.”
Other Serious RisksDepression, worsened sleep apnea, and a strong association with suicide are other risk factors to consider when considering sleeping medication.
Suicide is also “strongly associated.”
The Food and Drug Administration (FDA) stated that sleeping pills shouldn't be taken by people with sleep apnea because of the risk of making it worse. Kripke has studied the prevalence of sleep-disordered breathing among people aged 40 to 64 years old and among community-dwelling elderly. His findings raise concerns about the widespread likelihood of people with sleep apnea also taking sleeping pills.
Complex Sleep BehaviorsThe bizarre risks of some sleeping medications are often most publicized because they're rare and seem highly improbable to the average person. These “complex sleep behaviors” include “sleepwalking, sleep driving and engaging in other activities while not fully awake, such as unsafely using a stove.” This gives serious meaning to the drugs’ classification as “hypnotics.”
Then-Acting FDA Commissioner Ned Sharpless said, “These incidents can occur after the first dose of these sleep medicines or after a longer period of treatment and can occur in patients without any history of these behaviors and even at the lowest recommended doses.”
Getting Off Sleeping PillsOn top of the significant risks of these medications, it appears that they provide very little benefit.
Nevertheless, it's important that you consult your prescribing doctor before discontinuing a prescribed sleeping medication, especially when considering withdrawing from larger doses.