Treating Insomnia: Say Goodnight to Sleeping Pills

Introduction

Insomnia can be a complex issue, often linked to mental disorders and stress. Studies show that insomniacs may be at risk of dying earlier than individuals who don’t suffer from this sleep disorder.

Sleeping pills also contribute to mortality risk factors for insomniacs.[1] Turning to cognitive behavioral therapy for insomnia (CBT-I) may lead to better results and a healthier outcome.

Keep reading to find out more about insomnia and the risks and ineffectiveness of taking sleep aids, like sleeping pills.

Insomnia Defined

Insomnia is a sleep disorder that makes it hard for you to fall asleep, stay asleep or get quality restorative sleep. Sometimes, the condition can cause you to consistently wake up earlier than desired.

If you have insomnia, you may be dealing with symptoms for months at a time (chronic), or symptoms can be present for just a few weeks (acute). With Insomnia, even though you’re extremely tired, falling and maintaining sleep can be difficult.

Sleeping pills can be perceived as the most efficient remedy for sleeplessness; however, they can have crippling side effects, including daytime drowsiness, addiction, suppressed breathing, and even death.

It’s clear that sleeping pills are not a solution for sleeplessness as they can mask an underlying condition, sabotage long-term health, and eventually become ineffective as your body builds up a tolerance.

Epidemiology

Studies show that over 5 million people visit the doctor annually for insomnia-related symptoms[2] and are prescribed and/or use sleep medications frequently:[3]

About 4% of U.S. adults aged 20 and over used prescription sleep aids in the past month.
The percentage of adults using a prescription sleep aid increased with age and education. More adult women (5.0%) used prescription sleep aids than adult men (3.1%).
Non-Hispanic white adults were more likely to use sleep aids (4.7%) than non-Hispanic blacks (2.5%) and Mexican-American (2.0%) adults.
Prescription sleep aid use varied by sleep duration and was highest among adults who sleep less than 5 hours (6.0%) or sleep 9 or more hours (5.3%).
One in six adults with a diagnosed sleep disorder and one in eight adults with trouble sleeping reported using sleep aids.

Causes

Any number of factors can cause insomnia, from emotional and medical issues to daytime routine and sleeping habits. Some of the known and leading causes of insomnia include:

Emotional or psychological problems include anxiety, stress, anger, depression, worry, grief, trauma, and bipolar and schizophrenia disorders.
Medical conditions include asthma, allergies, acid reflux, cancer, kidney disease, hyperthyroidism, endocrine problems, and chronic pain at night. Also, urinary, respiratory, cardiac, and neurologic problems can have insomnia as one of their symptoms.
Prescription drugs such as high blood pressure medications, contraceptives, antidepressants, thyroid hormones, corticosteroids for asthma, and stimulants for ADHD.
Over-the-counter medications, like diet pills, diuretics, cold and flu medications containing alcohol, and pain-relieving drugs that contain caffeine (e.g., Midol, Anacin, Excedrin). [4]
Use of hard drugs.
Poor sleep hygiene, like chronic napping, irregular sleep/wake schedules, or an uncomfortable sleeping environment.
Caffeine, alcohol, or tobacco use.
Advanced age.
Undiagnosed or poorly treated sleep disorders, like restless legs syndrome, sleep apnea, or shift work sleep disorder.

Risk Factors

There are multiple factors that can predispose you to insomnia. These can be classified into three main categories.

1) Predisposing Factors

Factors that increase the risk of experiencing insomnia:

History of childhood or interpersonal trauma
Chronic mental health conditions, depression, or anxiety[5]
History of shift work or erratic sleep-wake patterns
Chronic pain conditions

2) Precipitating Factors

Certain events that lead to sleep disturbance:

A severe accident leading to physical injury
Divorce or death of a spouse or close family member
Change in an occupation, such as loss of a job or transition to a new job

3) Perpetuating Factors

Behavioral and cognitive drivers that sustain poor sleep over time:

Watching television in bed while trying to fall asleep
Staying in bed for extended periods of time in an effort to obtain more sleep or taking long naps during the day
Anxiety and worry about sleep loss
Excess caffeine intake

Sleeping Pills

Sleeping pills are commonly prescribed as a treatment for insomnia, whether it’s experienced independently or as a symptom of another disorder; however, they’re not effective for long-term use, and result in serious short- and long-term side effects.

Evidence suggests that the longer sleeping drugs are taken, the less effective they become.[6] This happens because the human body can build up tolerance in as little as a few weeks. Sleeping pills can only help you fall asleep 10 minutes faster and increase your snooze time by a maximum of one hour.

Effects of Sleeping Pills

While sleeping pills can work for a short duration, long-term use can interfere with the quality of your sleep. Secondly, they won’t cure your insomnia, and they’ve been linked to undesirable side effects, such as residual morning drowsiness, forgetfulness, and confusion.[7]

Taking sleeping pills for an extended period can worsen your symptoms and lead to adverse effects like a higher death risk. An extensive study involving a total of 34,205 participants found that frequent users of sleeping medications have a 4.6 times higher mortality rate and a significant increase in developing cancer than the control group.[8]

The addictive potential of sleeping aids is another unpleasant side effect of the regular use of these drugs. It’s another reason doctors recommend using them as little as possible to avoid an over-dependence on them.

If you’re already addicted to sleeping pills, the best way to wean yourself off is to stop using gradually (under your doctor’s supervision) to avoid a sharp withdrawal response.

What is CBT-I?

Studies have shown that cognitive-behavioral therapy for insomnia (CBT-I) is the best long-term treatment that can help break the cycle of sleeplessness.

CBT-I is a type of therapy that aims to identify and change negative thoughts, feelings, and behaviors preventing you from getting a good night’s sleep.[9]

Unlike sleeping pills, CBT-I is a drug-free method and is usually the preferred first line of treatment recommended for insomnia. Though it requires more time and effort, CBT-I remains the best remedy because it’s a healthier way to manage chronic lack of sleep. Furthermore, it works well for short- and long-term use and has none of the side effects and dependency issues of sleeping pills.[10]

To undergo CBT-I treatment, you’ll meet with a sleep or CBT-I therapist who will work with you to uncover the underlying factors causing your sleep problems. The next step after that is to help you find coping strategies that would make you respond or tackle those issues more effectively so your sleep quality can improve.

Why is CBT-I Effective?

On its own, the CBT-I is the best psychological treatment currently available in the medical field. Pointing to all available evidence, this treatment is considered the gold standard of psychotherapy.

According to the study, a treatment method only gets conferred with the gold-standard status if it is evidence-based or has been tested with the most stringent criteria (e.g., randomized controlled trials) similar to those used in pharmacotherapy.[11]

Many insomniacs struggle with worries, and negative thoughts are at the root of their sleeplessness, the CBT method was tailored into CBT-I to address insomnia.

A systematic review and meta-analysis done in 2015 on the efficacy of the CBT-I method showed that on average, people who had their insomnia treated with this method fell asleep 20 minutes faster while spending 30 fewer minutes awake at night as compared to people who did not undergo CBT-I.[12]

CBT-I for Children

Just like how CBT-I is effective for adult insomnia, the therapy also works well in children. In fact, health care professionals are more likely to prescribe cognitive behavioral therapy treatment over sleeping pills for a child or teenager who has trouble sleeping well.[13]

CBT-I is readily available through online consultations, group therapy, or face-to-face sessions, but for minors, a parent has to be present. The CBT-I approach involves helping the child replace an unhealthy bedtime regime with more sleep-friendly hygiene practices.

Benefits of CBT-I

CBT-I doesn’t have health risks associated with it; however, it requires more effort than just taking a pill. It’s drug-free and delivers higher sleep satisfaction that can be sustained up to 6 months after treatment. CBT-I therapy may be repeated if insomnia recurs. Additional benefits you can gain from CBT-I are

No Residual Symptoms
More Sustained Sleep Improvement
Higher Rate of Remission[14]

Conclusion

CBT-I gives you the tools to overcome insomnia while avoiding the health risks associated with sleeping pills. Studies of CBT for treating Insomnia show that it is a healthier option and can be used both for adults and children.

If you’re interested in using this approach to overcome your insomnia, make an appointment with your doctor. Before you go, it will be helpful to keep a 2- to 3-week personal record or diary of your sleep pattern for your doctor to evaluate.

References:

Sivertsen, B., Madsen, I. E., Salo, P., Tell, G. S., & Øverland, S. (2015). Use of Sleep Medications and Mortality: The Hordaland Health Study. Drugs – real world outcomes, 2(2), 123–128. https://doi.org/10.1007/s40801-015-0023-8
Ford, E. S., Wheaton, A. G., Cunningham, T. J., Giles, W. H., Chapman, D. P., & Croft, J. B. (2014). Trends in outpatient visits for insomnia, sleep apnea, and prescriptions for sleep medications among US adults: findings from the National Ambulatory Medical Care survey 1999-2010. Sleep, 37(8), 1283–1293. https://doi.org/10.5665/sleep.3914
Chong Y, Fryar CD, Gu Q. Prescription sleep aid use among adults: United States, 2005–2010. NCHS data brief, no 127. Hyattsville, MD: National Center for Health Statistics. 2013. https://www.cdc.gov/nchs/products/databriefs/db127.htm#:~:text=About%204%25%20of%20U.S.%20adults,than%20adult%20men%20(3.1%25)
Stepnowsky, C. J., & Ancoli-Israel, S. (2008). Sleep and Its Disorders in Seniors. Sleep medicine clinics, 3(2), 281–293. https://doi.org/10.1016/j.jsmc.2008.01.011
NHS Inform Scotland (April 21, 2021). Insomnia causes and treatments https://www.nhsinform.scot/illnesses-and-conditions/mental-health/insomnia
Stanford Healthcare. Who is at risk? (n/d). Retrieved April 12, 2021, from https://stanfordhealthcare.org/medical-conditions/sleep/insomnia/causes/who-is-at-risk.html
Fitzgerald, T., & Vietri, J. (2015). Residual Effects of Sleep Medications Are Commonly Reported and Associated with Impaired Patient-Reported Outcomes among Insomnia Patients in the United States. Sleep disorders, 2015, 607148. https://doi.org/10.1155/2015/607148
Scripss Health. (Feb 27, 2012). Higher death risk with sleeping pills. Retrieved 12 April 2021, from https://www.sciencedaily.com/releases/2012/02/120227204830.htm
Reddy, M. S., & Chakrabarty, A. (2011). “Comorbid” insomnia. Indian journal of psychological medicine, 33(1), 1–4. https://doi.org/10.4103/0253-7176.85388
Runko, V. (2021). Cognitive Behavioral Therapy for Insomnia (CBT-I). Virginia Runko, PhD, CBSM Behavioral Sleep Medicine Specialist Licensed Psychologist The Ross Center for Anxiety and Related Disorders, Washington DC https://adaa.org/sites/default/files/Runko_177.pdf
David, D., Cristea, I., & Hofmann, S. G. (2018). Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy. Frontiers in psychiatry, 9, 4. https://doi.org/10.3389/fpsyt.2018.00004
Trauer, J. (2021). Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis: Annals of Internal Medicine: Vol 163, No 3. Retrieved 12 April 2021, from https://www.acpjournals.org/doi/10.7326/M14-2841?articleid=2301405
Dewald-Kaufmann, J., de Bruin, E., & Michael, G. (2019). Cognitive Behavioral Therapy for Insomnia (CBT-i) in School-Aged Children and Adolescents. Sleep medicine clinics, 14(2), 155–165. https://doi.org/10.1016/j.jsmc.2019.02.002
Overview – Cognitive behavioural therapy (CBT) (July 16, 2019). Retrieved 12 April 2021, from https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/