In 2010, Canadian pharmacists filled a staggering 5.6 million prescriptions for sleeping pills. Of these 5.6 million prescriptions, approximately 60% were for women between the ages of 40-60. You may be asking yourself, who cares? What’s the big deal? The problem is that most cases of insomnia can be managed with non-drug therapy and when sleeping pills are needed, they should be used for a maximum of 14 days. In reality, we as pharmacists see that most 1st time prescriptions are for 30 pills (or 30 days) and many have additional refills. Keep reading to find out why this is a major health concern.
What is insomnia?
Insomnia is defined as difficulty falling asleep, difficulty staying asleep or non-refreshing sleep in a person who has the opportunity to acquire a normal night’s sleep of 7-8 hours. However, the insomnia only requires therapy if it is in combination with daytime dysfunction or distress such as fatigue, poor concentration and irritability.
Insomnia is quickly becoming an epidemic across North America, and it is not being properly managed. Insomnia should be treated by changing behaviours and sleep patterns through non-drug measures. However, in most cases, sleeping pills are prescribed before non-drug measures are tried and this may be costing many their lives.
Do sleeping pills increase your risk of dying?
A study published in British Medical Journal on March 12, 2012 found that taking sleeping pills can increase your risk of death. In fact, they found that taking 17 pills or less per year had a 3.5 times greater risk of death on a 2.5 year period compared to those who took none. Those who took 18-132 pills per year were 4 times more likely to die in a 2.5 year period, and those who took over 132 doses or more were more than 5 times more likely to die. In addition to increasing the risk of death, those who took the most pills also had a significant increase in the incidence of cancer. The study did not determine if this increased risk of death and cancer disappears after a certain period of time. More studies on the negative effects of sleeping pills need to be completed for us to better understand the long term implications of using these medications.
What does this study tell doctors and pharmacists?
This study is telling us that currently, sleeping pills are being over prescribed and this is causing patients harm, in fact it may be killing them. Doctors need to look at their prescribing habits when it comes to these medications and think twice before they write prescriptions for them. Pharmacists need to be vigilant in educating patients about the risks associated with these medications and recommend smaller doses for shorter durations. Both doctors and pharmacists alike should be educating all patients on non-drug methods that can be used to improve sleep.
What does this study mean for those suffering from insomnia?
This study is telling us, that insomnia needs to be managed with non-drug measures, and that sleeping pills should only be used in some cases. It is also telling us that if someone requires a sleeping pill, they should only receive 7-14 tablets to be used on a short term basis until sleep can be restored using behavioral techniques.
How is insomnia managed without sleeping pills?
In most cases of insomnia, sleeping pills should not be necessary. Sleeping pills are a band aid solution to an underlying problem. It is important to try and find a cause for the insomnia. Insomnia can be caused by depression, anxiety, hormone imbalances, restless leg syndrome, chronic pain, acid reflux, breathing disorders and medications. In these cases insomnia can be resolved by treating the underlying condition. When there is no known cause of the insomnia, there are many non-drug measures which should be tried before sleeping pills are prescribed or in combination with sleeping pills.
Non-drug measures include:
- Ensuring good sleep hygiene
- Sleep consolidation techniques
- Stimulus Control
- Relaxation Techniques
The goal with each of the above behavioural techniques is to work towards getting 8 hours of sleep each night. Speak with your pharmacist to learn how to use each of these techniques to improve your sleep today.
What you should do if you have been taking sleeping pills for a long time?
If you have been taking sleeping pills for a long period of time you will need to slowly decrease the dose until you are no longer using the medication. Additionally, you will need to learn techniques that will help you sleep properly once the sleeping pill is discontinued. Stopping “cold turkey” will result in withdrawal and rebound insomnia. If you have been taking sleeping pills and would like to stop, speak to your doctor or pharmacist today.
What should you do if you think you are suffering from insomnia?
If you think suffering from insomnia, you should speak with your pharmacist or physician to be assessed. Insomnia is a medical disorder that requires therapy. Underlying causes of insomnia need to be considered and ruled out before therapy begins. Most importantly, treatment of insomnia should always begin with behavioural modifications and non-drug strategies to improve sleep. If drug therapy is required, it should be prescribed at the lowest effective dose for the shortest duration possible. Sleeping pills should never be used without education on proper sleep hygiene.
Speak with your pharmacist today to learn more.