It’s 4am, you’re tossing and turning in bed, in what is yet another night where you can’t fall asleep. Perhaps you’re anxious about something, your thoughts are racing, or you’re restless. Whatever it is all you’re thinking about in your mind is how badly you just want to sleep, how not sleeping is going to affect your day tomorrow. It is very possible that in that moment you turn to sleep medication as an easy way of falling asleep. You might feel relief at first that you have finally had a proper night’s sleep but what if taking that pill was the start of a dark road. In this feature I am exploring the dangerous affects that sleep medication can have as well as the long term risks it can cause. I will also explore the healthier approaches that can be taken to curing insomnia.

I spoke to Reena Koli a middle aged woman from Dundee who has had a history with insomnia and once resorted to taking sleeping pills as a solution. She said, “It started with one night where yet again I just couldn’t sleep and it was like oh here we go again. I was desperate for a quick fix just something that would get me to sleep that night not focusing on the side effects or addiction or anything like that.”

Often in these cases sufferers seek help as they are keen to overcome this issue.

Koli added, “I had been to see my local GP on one or two occasions and on the last one he prescribed me some sleeping pills called diazepam that I was only to take for a very short period. And so on this night I took these pills called diazepam and I was out just like that. I woke up feeling great initially, to be honest I was ecstatic that I had been able to sleep and that these pills had actually worked.”

Diazepam which is a type of benzodiazepine although effective is very addictive and can easily develop tolerance in those taking it.

“I remember feeling really weird when I got out of bed as if something wasn’t right with me. I could almost compare it to the symptoms of a bad hangover, my head was sore, I felt foggy and just very dehydrated. At that moment I said to myself that I wasn’t going to take those pills again and it was just for that one night. I wanted to be able to sleep normally without having to take anything.”

In many cases of insomnia it can be often due to sufferers feeling immense pressure when it comes to sleep and overthinking it in general.

“By the time it came to going to bed I didn’t actually feel worried or anything about it. I think having slept the night before took the pressure off it a bit. Anyways jumping ahead a bit it comes to around 3 in the morning and low and behold I’m not sleeping again and what do I do, I take another pill. The dose I had been given was 2 weeks.”

GPs or Doctors won’t prescribe sleeping pills for more than 4 weeks in any case as there are serious risks to taking them for too long.

“Fast forward to a few weeks later and I still wasn’t sleeping. It felt like I couldn’t get to sleep without these pills anymore. I relied on them to feel sleepy and without them I was hopeless. It felt like I had taken one step forward when I was on them just to take 2 steps backwards after.”

Dr Kapil Chawla who is a Private General Practitioner at The Wellington Diagnostics Outpatients Centre in Borehamwood provided me with more insight into the medication involved in sleep and the side effects of them.

He said, “I do give sleep medication to some of my patients. But you have to really find the reason. Why should they be on it? What is it that they can’t change? Because there has to be a reason which is stopping them from sleeping.”

Dr Chawla mentioned serious diseases for example someone who has cancer and are having chemotherapy. They may be in severe pain which cannot be relieved and might be taking painkillers that aren’t helping too much.

He added, “In that case it is ok to prescribe sleeping pills. But if it is a case of mental health or other factors you don’t give them sleep medication straight away because it can become a reliance. You get used to taking them and have to keep increasing the dose further and further. Some patients come to me and say ‘my doctor has given them to me for the last 15 years’ and in that instance, I always reply saying that if they want to see me, I’m not going to give it to them forever and they really have to agree to come off it.”

“In terms of what medication I prescribe there’s something called benzodiazepine more known as diazepam but these develop tolerance very easily and I try to avoid prescribing them at all costs. There are newer variants called zolpidem, zopiclone known as z drugs.”

They are the common sleeping pills prescribed especially in the UK but are a short-term solution as they develop tolerance after a few weeks.

“We can also prescribe something called promethazine which isn’t actually a sleeping pill but more of an antihistamine. They gave a sedative effect and I give them to my patients.”

They cross the blood brain barrier and get inside the brain, acting on some of the receptors which are on the reticular activating system (RAS). So it numbs the senses as all the information coming from the senses go to RAS. This drug goes and blocks the RAS receptors and then they sleep because there’s no sensation coming through.

To get more of an insight into the ways around medication, I spoke to Dr Priya Sharma, a consultant psychiatrist who works at Coathill hospital, part of NHS Lanarkshire in Glasgow, often treats patients struggling with insomnia.

“The main thing I notice in patients I see is that before they come to see me, they haven’t taken the time to consider what is actually causing their sleep issues. I’ve seen so many patients who come to me and want to be put on medication, but I always ask them, ‘Have you assessed what the problem may be?’”, said Dr Sharma

Dr Sharma expressed the importance of considering these factors before anything else. She added, “The number one problem is always sleep hygiene. Now, what that means is things such as blue light, so are devices such as phones, iPads, laptops, which produce blue light, keeping you awake. Caffeine, which is known to prevent sleep. So avoiding drinking tea, coffee, energy drinks a certain time period before bed. Alcohol, going to bed late, lack of consistent routine, stress, economy, lack of sunlight.”

Lack of sunlight is a very big thing because it ties in with the circadian rhythm. It’s basically your bodies internal clock. For our circadian rhythm to be intact we need daylight. It’s things such as daylight that help regulate our internal clocks and shift our circadian rhythm. As the sun sets our brains start to produce a hormone called melatonin which makes us sleepy.

“If our circadian rhythms are off then it affects this production of melatonin. In a lot of instances, it can be mental health issues that are affecting our sleep, such as anxiety or depression. I get a lot of patients who have anxiety at nighttime in relation to problems occurring in their life, such as work stress, financial struggles or often they’re just anxious about sleep itself. It tends to be a case where they’re busy throughout the day or distracted, so when they go to bed at night, all these worries and thoughts come all at once.”

There are methods and things to consider such as mindfulness and meditation. 

Dr Sharma finished by saying, “Generally I try not to prescribe medication but instead weigh up their quality of life and if it’s being very badly affected then I may go down this route.”

Overall it is clear that sleeping pills are not a sustainable solution to insomnia. If anything, it is better to avoid taking them, even just for a short period. There are healthier ways to solve it, which don’t have side effects and cause addiction. Masking over the real issues by taking a pill is never beneficial to someone, and if anything, just leads them down a dangerous road that, in Reena’s case, may be very difficult to come back from.