Sleep Medication- Worth the Risk?
FULL DISCLOSURE: the idea for “#Our Series on Sleep” came from my own past experience with insomnia. About 10 years ago, a neurologist put me on “this great new medication” to help me sleep better and therefore eliminate my migraines. That medicine was Ambien, and it led me down an extremely frustrating ten-year struggle to get off of it.
As a physical therapist who works with women with breast cancer, I hear frequently about the use of prescription sleep aids (Ambien, Xanax, Ativan, Lunesta, …) to help with sleep. I totally get it. A cancer diagnosis is the perfect storm for sleep disturbance- not only do you have PLENTY of new things to worry over, the treatment itself can keep you awake. Oh and then the double-edged sword of needing to sleep to recover from the treatment. It’s easy to see why sleep medicine is so widely used.
Today’s article about sleep aides is intended to give you some of the info I wish I had when first embarking on my relationship with Ambien. If I had a more thorough understanding of the medicine beforehand, I would have definitely made different choices.
It’s complicated.
Dr. Arash Asher is the director of the Cancer Survivorship and Rehabilitation at Cedars Sinai in Los Angeles, and often councils his patients about sleep. I was hoping he could give me a simple straightforward answer regarding the merits of sleep medicine. Of course, the answer is, it’s complicated. “I never try to make any claims about sleep medications being ‘good’ or ‘bad’.” Asher said, “Like all things in medicine, we have to weigh the potential risks and benefits.”
The benefit of not spending the night staring at the ceiling is obvious. Let’s take a deep dive into some of possible risks.
They can lead to Dependence.
This means the longer you take it, the more you will need to achieve the same result. This also means that when you stop taking it you will develop withdrawal symptoms.
You forget how to sleep.
Being able to put yourself to sleep is a thing. Anyone trying to sleep train a newborn will attest to that. It’s a skill that requires calming the mind and letting go of thought. If we neglect a skill (piano lessons, I’m looking at you) we start to lose them. Self-soothing to fall asleep is one of those skills.
You might eat in your sleep.
This one is most associated with Ambien. A common side effect is doing something with no memory of it in the morning, including eating, texting, online shopping, sex and most dangerously, driving a car!
They may be bad for your health.
In addition, sleep medications lead to increased falls among older adults, can be expensive, and may lead to potential cognitive impairments. Per Steven Chee, MD, LaC, of Chee Integrative Medicine in Beverly Hills ,“There has been some research to suggest that some benzos may have some links to cancer if used over many years.”
It’s not actual sleep.
Wait, what?
There is new research that indicates Benzodiazepenes, a class of medication that includes Xanax, Ativan and Valium, can be very detrimental to sleep quality. In other words, there is a difference between sleeping and simply being unconscious. (This totally explains why you never see someone past out drunk wake up bright eyed and bushy tailed the next morning.) As discussed in xxx, sleep has very specific phases that allow for healing and recovery to occur.
Sooooo why did my doctor give me this if it’s bad for sleep?
Good question, but as I said, this is a very novel way of thinking and research is still being done. I spoke to Melissa Sacco, MD, who works in pediatric critical care at University of Virginia, and she told me the practice at UVA is to now avoid giving Benzos to kids in the hospital, precisely because it interferes with sleep. It’s possible we will see the medical field as a whole begin to move in this direction, but these things take time.
Dr. Asher sums it up this way: “The challenge again is that it’s much easier for us physicians to take 30 seconds to prescribe a drug than it is to offer some strategies that probably have longer-lasting results, such as cognitive-behavioral-therapy for insomnia programs (now available on-line) which is felt to be the optimal standard for dealing with insomnia from major sleep guidelines (but hardly ever actually used due to costs barriers, taking the time and discipline to learn the approach, etc). “
Who doesn’t want to just take a pill to solve a problem? The temptation to skip the behavioral therapy, the sleep hygiene, and the meditation techniques is SO STRONG. And it may be totally appropriate. When I was in the darkest depths of my insomnia, I would laugh maniacally at anyone who suggested I try scenting my pillow with lavender oil. My insomnia was a gigantic monster that could only be sedated by prescription.
If you and your doctor decide a sleep aid is right for you, here are some things to consider:
Are non-prescription sleep aids an option? Melatonin can be very effective and does not have the same risky side effects. Dr. Chee once told me people often believe melatonin doesn’t work for them, but it’s possible they are taking too low of a dose. Per WebMD, the standard dose is 1mg to 6 mg, however always best to check with your own doctor versus the interwebs before adding a supplement.
Is cannabis legal in your state? In California, medical cannabis is being prescribed more and more for sleep issues. Stay tuned for upcoming blog post devoted entirely to this topic.
If you are going to take a prescription, think of it as a “just in case” option versus what I did of “and now I’m going to just take this every night until the bottle runs out!” This might mean a few times a week you have a bad night’s sleep, but that’s ok. You and your sleep will be better off in the long run with this approach.
