Friday, March 28, 2014

Sleeping Pill Use Rises as Risky Patterns Emerge

About 3.5% of US adults, or 6 million people, reported using prescription sleeping pills in a one-month period in 2009-2010, up from 2% in 1999-2000, researchers from Harvard Medical School reported in the February issue of the journal Sleep.
March 7, 2014

The Centers for Disease control and Prevention recently found similar, though slightly higher usage rates.

One obvious reason for the increase: two decades of marketing for the latest generation of pills, including zoipidem (Ambien), the drug that got Kerry Kennedy in trouble. But experts in sleep medicine say they are less worried about how many people are using the pills than about who it taking them and how.

Of particular concern, 55% of users in the latest study were also taking other sedating drugs, and 10% were taking three or more, most often opioid painkillers and benzodiazepines. While some older sleeping pills, such as triazolam (Halcion), are themselves benzodiazepines, the category also includes anxiety medications such as Xanax, and Ativan.

The fact that so many people are mixing these medications “actually makes me nervous as someone who drives down the road,” say Harvard researcher Suzanne Bertisch. Bertisch says that the heaviest users of sleeping pills are the oldest adults. The new study found 5% of people over 80 taking the medications. “Pretty much nobody over 80 should be on these medications.” Bertisch says, given the risks for daytime drowsiness, cognitive impairment, dizziness, falls and other side effects.

It’s not surprising, though, that so many elderly people and people on multiple medications take sleeping pills, says Daniel Buysse, professor of psychiatry at the University Of Pittsburgh School Of Medicine. About 10-15% of the population has chronic insomnia, and people with other mental and physical health problems are disproportionately affected, he says. “Depression, anxiety, substance abuse, schizophrenia, bipolar disorder – every psychiatric disorder is associated with sleep problems,” he states. So are painful conditions such as arthritis.

The average American takes four prescription medications daily. We know very little about what most drugs do in the body. We know almost nothing about the interactions between multiple drugs. Sleeping pills only treat a symptom and often create side effects that are worse than the insomnia.

Sleep issues are probably more common than this report indicates. “How well do you sleep,” is a question I ask of every new patient. There are two basic forms of insomnia – Maintenance insomnia is when you wake up in the middle of the night. Your mind starts to work and you can not seem to shut it down. Onset insomnia is when you lie down to sleep and regardless of how tired you feel, you can not shut down the mind.

Both of these problems are related to adrenal stress. Typically, onset insomnia is the more severe adrenal issue than maintenance. High cortisol, released from the adrenals is the culprit.

Cortisol naturally increases slightly as we sleep each night. In small amounts it helps maintain blood glucose levels by stimulating release of glycogen (stored sugar) from the liver. However, excess cortisol over stimulates and once you are awake you can not get back to sleep.

As the adrenals produce more cortisol, they produce less of all the other sex hormones including estrogen, progesterone, and testosterone. Eventually, without treatment, the adrenals only produce cortisol. This is a real issue as we age, going through andropause and menopause, we require more and more production of sex hormones from the adrenals.

If you have maintenance insomnia, try eating some protein at bedtime. This will help you maintain your blood glucose and the need for increased cortisol production should diminish. The herb Chaste Tree can be very effective as well. When taken early in morning, it promotes the body’s natural production of melatonin. Melatonin activates in the dark, so make sure your room is dark when you go to sleep. If you still have difficulty sleeping, have your cortisol levels checked. Our stressful lifestyle fatigues the adrenals over many years. Often adaptogens like Ashwaganda, Rehmannia, Korean Ginseng, or Tribulus can help rebuild the adrenals.