Q: I read that prescription sleeping aids are linked to increase risk of death. Does this mean I should stop my insomnia prescription?
A: You are referring to the the British Journal of Medicine article published in February. Indeed the study demonstrated a link between the use of prescription sleeping aids and death. Factoring out a range of conditions that can lead to death didn’t weaken the relationship. What the article does not conclude is that the medicines to induce sleep caused the deaths. The most common drugs used in this study were zolpidem (Ambien) and temazepam (Restoril) though all insomnia prescriptions seemed to carry the increased risk. It could be that these drugs are causing more harm than we realize it is much more likely that there are serious underlying medical conditions that presents first with a disturbance of sleep. So while the insomnia medicines helped these patients to get to sleep the underlying condition that caused the insomnia was not identified or treated. This condition is what leads to the early death of some of these patients.
What made it seem so convincing in this study was there was a “dose dependant phenomenon.” This means that the more often an insomnia drug was used the larger the increase in the death rate. So those taking the most doses had the highest risk. This certainly may be because those with the most serious underlying conditions also had the worst insomnia.
So what should you do with all this information? The most important thing is to ask what is causing the insomnia. Is there a medical condition that is not being addressed fully? Such as hypertension, frequent urination at night, shortness of breath, snoring, restlessness, body pains, muscle cramps, headaches, stomach aches, palpitations or night sweats. Are you excessively stressed, depressed, anxious, or drinking too much alcohol? Ask your doctor to run tests to confirm that your known medical conditions are well treated. Ask your doctor to screen you for common conditions like heart disease and cancer. Ask your doctor if any of your medicines could be contibuting to your insomnia. In particular ask your doctor to check your blood oxygen levels while you sleep at home. This is easier that you imagine. All oxygen supply companies can arrange for you to be tested with an oxymeter, a small device that you wear on your finger at night. I records both your oxygen level and heart rate and is very inexpensive. It is likely that much of the increased risk of death associated with insomnia drugs is from undiagnosed obstructive sleep apnea. This condition is common and underdiagnosed. It is also an immense stress on the heart that could easily lead to an early demise. What is more, many people have premonitions of their death. This may make sleeping difficult as for many sleep represents a minideath. Simply taking a sleeping pill masks the premonition of death without dealing with the information that is trying to come through to the patient.
If it still makes you uneasy to continue your prescription then you may try a more natural sleep remedy. The most commonly used in my office include, l-tryptophan, melatonin, magnesium, magnolia, and GABA (gamma aminobutyric acid). L-tryptophan has been used for many decades and is very safe and effective. It is taken before bed at doses of 500mg to 2000mg. It must be used with caution with antidepressants. It has a more immediate effect than its sister 5-hydroxytryptophan.
Melatonin in my practice has a disappointing history until recently. It often worked but patients complained of disturbing dreams. An australian study used in combination with magnesium and zinc with remarkable effectiveness. Not only did it work more often but the disturbing dreams also disappeared. They used melatonin 4-6mg, zinc 10mg, and 225mg of magnesium. Try it.
Preparations with herbal magnolia are particularly good for stress induced insomnia. You may find it in combination with other calming herbs such as valerian or passion flower. Those who have anxiety with their insomnia may benefit from taking GABA, 200-700mg at night. GABA is very safe and may be use in combination with other sleeping aids.
Be sure to prepare for sleep well. Avoid excesses of caffeine, alcohol, or disturbing media content in the evening. Get to bed before 10pm. Avoid eating late at night. Avoid watching disturbing media content at night. Avoid discussing emotionally charged issues with your loved ones. Though I also recommend not going to bed with your partner with heavy unresolved issues. Conclude such discussions with love even if you are going to have to resolve the discussion later.
Nexus July/August 2012