By Dr. Victor S. Sierpina
When you hear the word “hypnotize,” perhaps you think of a psychotherapy technique or even a stage act where someone is induced to bark like a dog while in a trance.
There is also a class of medications called hypnotics. The hypnotic drugs are very commonly prescribed for sleep disorders. They are heavily advertised as well.
I would like to educate you about some concerns that have been raised regarding the chronic use of these medicines, sold under trade names such as Ambien, Lunesta and Sonata.
Insomnia affects approximately 10 percent of the U.S. population and is a troubling condition for many people. Though sleep experts recommend seven to nine hours of sleep nightly, American adults average only 6.9. Acute sleep deprivation for just a few days can cause mental, behavioral, metabolic, autonomic problems, and even a decrease in immune function leading to increased risk of infection.
Chronic “sleep debt” from sleep deprivation is associated with increased risk of diabetes, cardiovascular disease, cancer, overall mortality and even car accidents. Clearly, getting a good night’s sleep is an essential part of good health.
Some people may have specific conditions affecting their sleep, such as sleep apnea, narcolepsy, rapid eye movement sleep behavior disorder, periodic limb movement and restless legs syndrome.
These require special testing and treatments beyond the scope of our space here.
Is the widespread use of hypnotics for sleep both safe and effective?
Hypnotics may be associated with tolerance, dependence and withdrawal symptoms, including rebound insomnia if the drug is stopped abruptly.
Side effects include nausea, vomiting, dizziness, somnolence and changes in taste. These medications also affect the brain waves and induce physical sleep without allowing the brain to reach the slow wavelengths needed for true rest.
Hypnotics may also impair driving, as noted in a recent article in the New England Journal of Medicine. Women, the elderly, and those with liver disease may not clear the drug Ambien, the best selling of the hypnotics, from their system by the time they awake.
This can leave them impaired with daytime drowsiness. This can in turn affect driving and other critical activities.
The modified-release, with both immediate and delayed release in one pill, was more likely to cause this alcohol-like impairment than the immediate-release form. Doctors should now be recommending dose reduction in these types of patients.
Are there alternatives to these medications?
Sleep experts recommend an approach called Cognitive Behavioral Therapy for insomnia. This includes:
1. Cognitive therapy — focused on changing false beliefs and attitudes about sleep
2. Sleep hygiene education — no pets in bedroom, limit caffeine and nicotine after 4 p.m., keeping the room cool, no watching the clock, no exercising within 2-3 hours of sleep
3. Bed restriction — reduce the time in bed to that actually spent sleeping but not less than 5 ½ hrs. After reaching 90 percent efficiency (ratio of time in bed to time asleep), start increasing time in bed by 15 minutes a week.
4. Stimulus control — go to bed only when sleepy, avoid TV, use the bedroom for sleep or sex only, go to another room if unable to fall asleep within 15-20 minutes, read or engage in other quiet activities and return to bed only when sleepy
Some of my favorite non-pharmacological measures include:
• Mind-body relaxation techniques: imagery, deep breathing, progressive muscle relaxation, mindfulness, alpha-wave induction, self-hypnosis. An excellent resource is The Relaxation and Stress Reduction Workbook by Martha Davis.
• Physical measures such as warm baths, soothing music or white noise, massage, sex, aromatherapy with essential oils such a lavender.
• Botanical medicines: valerian, camomile (especially good for children), hops, catnip, passionflower, and lemon balm. These are traditional herbal remedies that can be taken as a tea, tincture or capsule. Sleepy Time Tea by Celestial Seasonings is a personal favorite. Melatonin and 5-HTP are two supplements that can also be helpful.
So before getting excited by a TV ad for the latest sleeping pill or reaching for a hypnotic to help you sleep, consider some of the risks involved. Realize there are a number of other safe and effective measures to help you have adequate, healthy sleep.
Dr. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine at the University of Texas Medical Branch and Professor of Family Medicine.