It’s common knowledge that many people who are desperate for sleep resort to taking sleeping pills without knowing the risks of sleeping pills. Insomnia – whether you have trouble falling asleep, or trouble staying asleep during the night – is a common health problem. Many of us were also raised to take a pill for every ailment. But is the idea that our bodies always need man-made chemical “helpers” to solve our problems true? Is it even a safe approach? As with most prescription drugs, there’s always a risk.
While you may be craving a good night’s sleep, it’s important to consider the potential risks of every prescription drug. The neurological effects and risk of dependency that comes with sleeping pill use are very real. However, those aren’t the only risks of sleeping pills.
How Genetics Matter
The first thing you should know is that genetically speaking, different people have a different responses to different drugs. Every substance we take in, and every metabolic waste product our bodies generate goes through liver detoxification. The first phase involves cytochrome-P450 (CYP450) enzymes making them more water-soluble. This happens to make the second phase possible, where the substance is bound to something else that inactivates it and allows for excretions.
Genetic variations influence how well these liver detoxification pathways work. Exactly which enzyme has a gene variation impacts your response to pharmaceutical medication too, with the CYP2D6 enzyme responsible for metabolizing up to one-quarter of common drugs. These include antidepressants, opioids and tamoxifen in the case of CYP2D6. If you’re an ultra-rapid metabolizer, you will have a poor response to as-is drugs, and a higher risk of toxicity when it comes to prodrugs. These, like codeine and tramadol, need the first stage of detoxification to activate them. Being a poor metabolizer will increase your sensitivity to drugs and reduce your response to prodrugs.
Over-The-Counter Sleeping Pills
Many people use antihistamines as easily accessible sleeping pills, as you don’t need a doctor’s appointment or prescription. Two common antihistamines are Benadryl (diphenhydramine) and Unisom (doxylamine succinate). These can cause daytime drowsiness, blurry vision, dry mouth, constipation and difficulty urinating. As they are mild enough to be sold over the counter, you may not think much of this. However, they can be annoying, and any warning label about operating heavy machinery is there for a reason.
Prescription Sleeping Pills, the Z-Drugs and Cognitive Function
In the 1980s, prescription sleeping pills known as the Z-drugs (zopiclone, zolpidem, eszopiclone and zaleplon) were seen as the next big thing. With fewer side effects relative to benzodiazepines, they were thought to be a safer method of helping patients catch some Z’s.
Z-drugs can have awful side effects, despite them now being the most common type of sleeping pills. For example, zopiclone is a sleeping pill that may impair verbal memory and working memory, while zolpidem affects verbal memory and attention. In another clinical study, participants had worse scores on working memory and on a driving test the day after taking zopiclone. Abilities we need for safe driving, such as reaction speed and tracking, were affected by the drug. Even though improving sleep generally boosts memory, the side effects of Z-drugs can more than cancel out this benefit.
Both benzodiazepines and Z-drugs may cause long-term cognitive damage too. Studies on their discontinuation after chronic use show persistent impairment in functions including memory, attention and reaction times. Sometimes, there’s still no improvement after six months, pointing to a long-term or possible irreversible loss.
How Hypnotics Can Be Deadly
The risks of sleeping pills can sadly include increased mortality. Out of 46 population studies comparing sleeping pill use to mortality risk, 43 found harmful effects while only one found a benefit. In another study involving over 34,000 patients, they were associated with a three to five times higher death rate.
Sleep meds are risky in high doses because they can suppress breathing. Their sedative effects come from a dampening of neuronal function, but you need your neurons to fire in order to breathe. Overdose generally happens when the affected person is asleep, or when the medication is combined with another sedative substance.
Could Sleeping Pills Cause Cancer?
Some research suggests that the risks of sleeping pills may even include cancer. In at least two studies, sleep meds have been linked to an over five-fold greater risk of cancer in men, but not women. Another found a six times higher chance of developing the disease with regular zolpidem use. Other drugs didn’t seem to have this downside.
One theory for this effect is that some drugs may reduce the amount of deep sleep, while only increasing the lighter levels of sleep. This impairs immunity, disrupts blood sugar control and reduces antioxidant status by lowering melatonin production, all factors that may increase cancer risk.
Sleeping Pills and Depression
With the dampening effect that sleeping pills have on our nervous systems, it’s no surprise that they could also increase our risk of depression. Multiple clinical trials report around double the risk of depressive episodes in people taking sleep meds. They weren’t flare-ups of previously diagnosed depression, but new episodes of the illness.
One theory of why sleeping pills may cause depression is their immune-dampening properties. Where a healthy immune system may identify and neutralize a threat before it becomes a chronic infection, one affected by sleep meds may not. An ongoing inflammatory response to a persistent pathogen could impact mood balance, as depression does have an inflammatory component.
Sedative drugs, such as sleeping pills, are associated with a higher risk of accidents at work and in everyday life. A loss of alertness, slowed reaction times and even negative psychological states can occur during the day with regular sleeping pill use, leading to devastating consequences. We know how scary it is to share the road with someone who is clearly not focused and alert enough to drive safely. What you may not know, however, is that half of the intoxication and dangerous driving deaths have hypnotics as a contributing factor. Switching to natural, gentler alternatives can benefit both you and your loved ones.
It’s no secret that pharmaceutical sleeping pills can be very powerful – and habit-forming as a result. The body’s physiological processes are maintained by negative feedback loops. For example, (perceived) high levels of a neurotransmitter will send a signal for its production to be turned down until levels fall low enough. When sleep meds have been keeping levels of sedative neurotransmitters high or occupy their receptors, we don’t make as much. This is likely why the withdrawal of drugs such as benzodiazepines can cause rebound insomnia and drug dependence.
Natural Alternatives to Sleeping Pills: What Can We Use Instead?
Perhaps you’ve already completed a DNA test and found out that you have a lower ability to detoxify from medications than average. Or, perhaps you or someone in your family has had severe side effects from sleeping pills. In any case, you want to avoid the risks of sleeping pills.
Alternatives to sleeping pills include improving one’s sleep hygiene, where you separate overstimulating things such as caffeine or social media scrolling from bedtime. There are also many natural, herbal remedies that can help you feel drowsy. Some work by reducing cortisol, the stress hormone that we need to wake us up in the morning. Others may increase relaxing neurotransmitters like GABA.
The health risks of sleeping pills can range from mildly inconvenient to tragic. And, as it turns out, you may not really benefit from them, as they could simply be increasing light sleep at the expense of deep, restorative sleep. If you are on sleeping pills or want to take them, we recommend a DNA test to check how well your body can detoxify drugs, and we’ll also include a sleep profile that details your sleep tendencies.