It’s been a week of tossing and turning in the bed. Your eyes are heavy and swollen, the dark circles refuse to fade away, and you can’t seem to concentrate through the day. You’ve tried everything that a quick Google search would recommend: meditation, exercise, diet, and that faithful cup of Chamomile tea right before bed.
Except, there’s still that last resort you are trying best to avoid: The sleeping pill. You know better than to fall into the ‘trap’ of pill-dependency - or that’s what the wisdom from those around you has made you believe.
But is this a fair judgement? Is sleep medication never a good option? We break it down.
How Do Sleeping Pills Work?
Dr Sayantani Mukherjee, Consultant, Psychiatry, Columbia Asia Hospital, Pune, tells us that ‘sleeping pill’ is a non-medical term: “The medical term for them is 'hypnotic agents'. There are different classes and categories of these medicines. They usually bring sleep by promoting secretion of relaxing and sleep-inducing neurotransmitters and hormones in the brain.”
These pills can be of various types, and are broadly classified into the following, according to Health.com:
- Hypnotics or GABA agonists: These target and activate the GABA receptors in the brain, which promote sleepiness.
- Melatonin receptor agonists: These target and activate the melatonins receptors,
- Orexin receptor antagonists: The newest class of sleeping pills, orexin receptor antagonists inhibit orexin, a neurotransmitter in the brain that promotes wakefulness.
In conversation with FIT, Dr Vikas Maurya, Director and Head of Department, Pulmonology, Chest & Sleep Medicine at Fortis Hospital, Shalimar Bagh, says, “Our body has sleep centres that control our awareness and alertness. Different kind of sleeping pills affect different receptors. Earlier, we had more broad-acting pills and less ‘selective’ pills. The older pills had more side effects like drowsiness during the day, mood disorders and even memory loss. But now, more and more refined medication is available which acts on the specific nerve centres.”
How Do You Decide Which Ones to Take?
You don’t.
Dr Maurya spells out why: “We should not take such medication on our own. Sleep medicines are prescription drugs and are not available over the counter. You can't get it without prescription. This is because a doctor needs to examine your history, rule out any other causes or underlying issues, and only then diagnose insomnia and decide which pills to give.”
When Do Doctors Prescribe Sleeping Pills?
According to Dr Mukherjee, sleeping pills must only be given when lifestyle and sleep hygiene measures fail, when insomnia is causing gross detrimental effects on general health, and when all other issues have been ruled out.
Facing trouble sleeping could also be a result of other chronic health issues of the heart and lung, hypertension, or mental health problems like anxiety, among others. In these cases, it is crucial to address the underlying disorder to eventually treat the secondary insomnia and sleep disturbances.
“Doctors look for the root cause, which is why self-medication is not advisable. When it’s anxiety, we often prescribe anxiety medication, which also helps induce sleep. When it’s a case of mild insomnia, we may try prescribing allergy or cold medication which often have a drowsy effect, instead of straight away going for sleep medicines. This could help break the sleep cycle.”Dr Vikas Maurya
Lifestyle modifications are sometimes enough to help with someone’s sleep issues, Dr Maurya adds. “We start with the basics and help alter a person’s sleep behaviour and patterns by advising them not to have caffeine, to exercise, to not watch television or have food right before going to bed, and more. But once these changes have been adopted and their medical history assessed, if they are still unable to fall asleep, we prescribe the most suitable sleep medication.”
What About Risks and Side-Effects?
While older versions of these pills had noticeable side-effects, newer, refined and more specific medicines available today are known to be safer, as and when recommended by a doctor.
“They are mostly safe unless one is allergic to them. Some classes of sleeping pills are addictive in higher doses and cause tolerance and lead to complications of potential abuse or overuse. This can harm memory, cognition as well as cause general underactivity of the brain and the nervous system.”Dr Sayantani Mukherjee
“Therefore, it is always better to ask and discuss with a doctor to clarify your doubts and know when to stop taking the medicine. Only a medical practitioner can guide you with the best possible medication or lifestyle alteration needed to treat insomnia,” he adds.
Christine Won, MD, associate professor of pulmonary medicine at Yale School of Medicine and medical director at Yale Centers for Sleep Medicine, tells Health that as long as you've been cleared by your doctor to take sleeping pills—and you're in contact with them about your experience on the medication, short-term use of sleep aids is fine, but remember that "sleeping pills are really just a bandage. Underlying issues—like an untreated sleep disorder, disruptive sleep environment, depression or anxiety, or an irregular sleep schedule--must eventually be addressed for long-lasting relief.”
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