Have you ever bothered to read the insert included with medication? It’s most often printed on thin paper, with text so tiny that most people need magnifying equipment to decipher it. It reminds me of one of the “fine print” in legal agreements. The similarities don’t end there. For one, this is also where pharmaceutical companies and attorneys hide the nasty stuff.
Take a look at the list of side effects. According to pharmaceutical companies, even the humble aspirin tablet can ruin your life. (For entertainment purposes I always imagine experiencing all the side effects.)
Nearly all sleep medication comes with an august list of side effects. Instead of a leaflet, the insert is often closer to a wad. What does that tell us? Sleep medication is not to be toyed with.
As a result, this is where my personal warning / disclaimer comes in. I will even type it in normally sized, legible text. This article is not intended as medical advice. It is imperative to consult a medical professional before taking any sleep medication.
Sleep – Like Love – Is Chemical
When you’ve exhausted all the other possibilities, made lifestyle changes, got the best mattress you can afford, and still suffer from insomnia, sleep medication can be a godsend. Sleep is regulated by a series of chemical processes. It is therefore open to external manipulation.
Enter, the sleeping pill.
Sleep medication works like any other external chemicals we introduce into our biochemistry. It is designed to trick our endocrine and nervous systems into reacting differently. Paracetamol, for example, artificially raises our pain threshold. It suppresses the secretion of prostaglandins, which our bodies use to sensitise nerve endings in case of injury or illness.
Avoid the Ham-Fisted Approach
There is a wide variety of sedatives available. You can go au naturel and take some valerian root or opt for a traditional opioid. The more adventurous among us, can try ketamine or nitrous oxide! Some people like to get mildly inebriated in order to fall asleep.
The problem with these examples is that they are a bit ham-fisted in the way they work. The best way to describe this would be one-size-fits-all. They will not only make you fall asleep, some will shut down large areas of your brain. This will leave you feeling like you’ve been hit by a bus when you wake up. We’re talking hangover territory here.
Fortunately, we have progressed way beyond that point when it comes to sleep medication. It has become much more precise and selective in its targeting of our brains and nervous systems. We don’t need to mess up our waking hours in a desperate effort to get some sleep any more.
Let’s take a look at the different types of sleep medication, the way they work, and their main side effects:
Different Types Of Sleep Medication
Benzodaizepines enhance the action of gamma-aminobutyric acid (GABA) in our brains. GABA is a neurotransmitter that suppresses brain activity by interfering with the way adjacent nerve cells communicate with each other. This explains its sedating abilities. It is particularly effective as an aid for falling asleep. Unfortunately it also tends to reduce the time we spend in deep sleep during a sleep cycle. Benzodiazepines are normally prescribed for short-term use only. This is due to tolerance quickly setting in. Subsequently, doses need to be increased to obtian the same benefits as before. A few examples are:
These medications differ from benzodiazepines in chemical structure, but they work in a similar way. They interact with brain receptors to effect an increase in GABA levels, therefore inducing sleepiness. What sets them apart is their targeting of more specific brain receptors. As the chemical disruption is limited to less brain receptors, non-benzodiazepines have fewer and less severe side effects. For one, it doesn’t interfere with our deep sleep. Unfortunately there is still some possible payback in the form of next-day fatigue, headaches and memory problems. Because of their euphoric effect, people often abuse these parmaceuticals. Non-benzodiazepines include:
3. Orexin Receptor Antagonists
Orexin is a neuropeptide that our brains use to regulate arousal, wakefulness and appetite. People who suffer from narcolepsy have a lack of orexin in the brain. Evidently, if we can suppress the activity of orexin a bit, we will feel sleepy. This is exactly what orexin receptor antagonists do.
As this is a fairly recent concept, commercially available medication of this type is predominantly still in development. The “appetite” -part of orexin’s functionality also complicates matters. Although orexin receptor antagonists are specific in their action, like non-benzodiazepines, they have similar side effects, mainly next-day drowsiness. Ironically, some people report sleep distrurbances, nightmares and sleep terrors. Due to these contradictions, we’ll have to wait and see.
Prescribing antidepressants in treating sleep problems has been around for a while, but it is falling out of favour slightly. It seems to be a hit-or-miss situation, as it works really well for some, while not for others. There is a wide variety of antidepressants available. They all have one thing in common: increasing serotonin levels in our bodies.
Serotonin has a complex relationship with sleep. It is active in sleep onset, wakefulness, and the REM -stage of our sleep cycle. Scientists are still figuring out how exactly this works. What they do agree on, is the simple fact that serotonin is essential for the production of melatonin. Without melatonin, we cannot fall asleep.
Antidepressants carry some of the most wide-ranging lists of side effects, which seem to differ from person to person. Some of the hosts of antidepressants are:
5. First-generation Antihistamines
The first generation of antihistamines differ from later generations because they have a sedative effect. Doctors prescribe them to alleviate the symptoms of allergic reactions, including those produced by colds and flu. Histamine is the chemical responsible for our runny noses, teary eyes and blocked airways. By inhibiting the function of histamine, these chemicals give us some relief. However, they are not terribly specific, as they inhibit the other function of histamine too. This chemical is also responsible for keeping us awake during the day.
Antihistamines carry a much shorter list of less severe side effects than antidepressants. They can still, however, cause a lot of unwanted side effects. Older people should not use antihistamines. Many doctors prescribe antihistamines for short-term use as a sleeping aid. The reason for this is that this medication looses their effectiveness rather quickly. Typical examples of first-generation antihistamines are:
When it gets dark, our pineal glands secrete melatonin, a hormone that makes us feel sleepy. In fact, without melatonin, it is nearly impossible for us to fall and stay asleep. Melatonin in tablet form is available over the counter at most pharmacies. It is a way to boost our melatonin levels artificially. You can make use of melatonin to help you fall asleep. Furthermore, if you are a shift worker, melatonin will send you off to dreamland. Lastly, melatonin is also usefull for thos that suffer from sleep disturbances.
In practice, taking extra melatonin has had mixed results, and the jury is still out as to its effectiveness. It has considerably less side effects than other types of sleep medication.
Unfortunately you can only fool your endocrine system for so long. If you keep taking sleep medication, your body will adjust to the new chemical levels. This can be causative of your body trying to normalise chemical levels.
Consequently, you now need to keep taking those chemicals to achieve equilibrium in your body chemistry. In other words, you need the extra chemicals just to feel normal, and then some more, to get the original sedative effect. That, in a nutshell, is dependency, which is a euphemism for addiction. Because of sleep medication’s euphoric effects it is very seductive. It is the most basic problem with almost all sleep medication. The ease with which one can slip into a habit happens very quickly.
Keeping the above in mind, we should view sleep medication as a temporary solution and not as a permanent fix.