As I’ve mentioned before, I am generally in favor of a limited use of sleeping medications. I believe these can help calm sleep anxiety until the effects of CBT practice begin to take hold. I believe they can take the edge off the sometimes frightening exhaustion that can set in after several nights in a row of very little sleep. I believe they can also help in treating nervous-system hyperarousal, a condition that is both a cause and an effect of long-term sleeplessness.
UPDATE–Please see my latest cautionary article about sleeping-pill addiction here…
Would I persuade people who wish to avoid drugs to take sleeping pills? No, nor would I tell someone who has experienced any kind of drug dependency to take them. I wouldn’t advise anyone to do anything they are not comfortable with, because the whole point of treating yourself for insomnia is to feel comfortable and relaxed, ultimately leading to better sleep.
What are the common questions people ask about medication?
Common questions people ask about medication include, which ones should they take, and how often should they take them? These questions should be answered by someone with medical expertise of course, but even when an expert is consulted, things might not go the way you wish. Some people respond better than others to certain medications, and some medications are more effective than others for certain people. So in the end it becomes a case of trial and error.
Dozens of prescription sleep pills are available these days, with more in the development pipeline, no doubt, as drug companies scramble to compete for the cash cow that is chronic insomnia.
Some are meant only to help you sleep, while others are more multipurpose, having either an anti-anxiety effect, anti-depressant effect, or in some cases, a pain relieving or even itch relieving ingredient as well. Some are designed for middle insomnia, and others for initial insomnia. Some are short acting, others longer acting. In addition to all this, each unique individual responds in a slightly different way, leading to some nearly opposite reactions to the same medication in people on either side of the spectrum. It’s complicated.
Most people with simple chronic insomnia who want the basic sleep aid such as Ambien can get it from their primary doctor. But if you are suffering from other mental conditions such as depression or generalized anxiety, OR if you are taking any other medication, you need to be cautious to avoid unwanted or dangerous side effects. Discuss medications you are taking with whatever doctor is prescribing them.
The best prescribers of pills that act on the brain and nervous system are specialists who work with these medications, know all their side effects, and understand their unique qualities. These would include psychiatrists, sleep doctors, etc. The extra trouble and expense is worth it if you are concerned about complications.
What are my own thoughts and experiences about medication?
My own experience with medication is pretty simple. During my worst episodes of insomnia, I took the common anti-anxiety medication lorazepam (trade name Ativan) in a low dose approximately two to three times a week. Those were the nights I could get some decent sleep. It stayed effective for as long as I used it. I did not take it before bed—I always waited for at least one hour after going to bed on the rare chance I might fall sleep on my own. I did not take it after 3:00 AM because of the drowsy morning-after effect this medication produced in me. If I had an earlier wake-up time, my cutoff point would have been earlier.
Why should no one take my own experiences as advice (disclaimer)?
When it comes to sleeping pills, no one should take anyone’s experiences as any kind of advice or indication that they should do the same thing. However, one thing I feel worth repeating: you want to take the smallest dose that is effective, and space it out widely enough to get you the minimum amount of sleep you need to feel functional while still being tired.
This avoids the dependency, whether physical or psychological, that none of us want. It also reminds you that sleeping pills don’t solve the problem of insomnia. And it also prevents developing resistance to the medication and needing ever stronger doses to get the needed effect.
This method requires some discipline, but for many of us, our desire to avoid unpleasant effects and dependency provides all the motivation we need. Some insomniacs who have already been prescribed sleeping pills are motivated to work harder on the cognitive and behavioral aspects of insomnia—because they want something that works on the root causes rather than just give temporary relief of symptoms.
But it is still important to understand how much having a reliable medication on hand can help with sleep anxiety. I doubt I could have continued normal life as a semi-functional individual without that.
What are the pros of medication?
Sleep anxiety, as we know, tends to grow worse as the clock ticks by. The later it gets, the more anxious we become. And as this cycle repeats itself for more than one night, the anxiety continues to grow. You can feel the layers building up as you become anxious about your anxiety, and then become anxious about feeling anxious about your anxiety. This is what I call the “snowball effect” of anxiety. After several nights of this, panic can set in.
Knowing that you can break some of this seemingly endless cycle by taking a pill is a relief.
The real value of medication for me was the psychological comfort of having it around in case of a very bad night, and I still keep some around for that very purpose. It is a security blanket of sorts, and works well in that role. Recently I had some trouble falling asleep, probably due to mental overstimulation (and possibly too much chocolate before bed). I considered the possibility of getting out of my warm bed to get my sleeping pills, and decided I was just too lazy to do that, and fell asleep on my own. Knowing it was there, however, allowed me some sense of comfort.
What is the main drawback to medication?
Besides the obvious side effects and the danger of addiction and/or resistance, there is the problem of psychological dependence. Even while rationing your doses, you could begin to think that you have lost the ability to fall asleep on your own. This thought can increase sleep anxiety, which is why you should always be using CBT techniques to challenge these thoughts while you are taking pills. The goal is to use the pills as a temporary crutch until you have changed your thinking patterns and behavioral habits.
What about insomnia medication that is designed to be taken daily, such as antidepressants? In that case, you obviously cannot determine your own schedule of when you take it. These kinds of drugs do not usually cause addiction or resistance. However, they can still give you the idea that you must take something in order to sleep. Many insomniacs are not happy with any psychological reliance on a drug.
What is a good way to solve this dilemma?
In any insomnia self-help program, it is important to understand that if something you are doing in the effort to help yourself is not working, you can always stop that activity and try something else. This is true of medication. If it’s not helping or even making things worse, you can always stop taking it, change it for a different one, or change the way you take it.
If your problem is ONLY insomnia and not some concurrent condition, such as depression or serious anxiety, and if you want to be more in control of when and why you take medication, then it makes sense to request something you can take on your own schedule, with full knowledge that you do need discipline to ration your pills. This is something to consider if you have had problems doing this in the past.
As always, the best approach is a proactive, positive one. While I recommend a combination of CBT, medication, and the various techniques of sleep hygiene as most helpful, a certain amount of patient experimentation is necessary for each individual. Knowing that you are ultimately the one who must decide how you want to treat your insomnia is a step in the right direction.