Sleeping Pill Safety: Candid interview with a sleep doctor
Almost as soon as news of actor Heath Ledger’s death broke, came news that sleeping pills were reportedly found in his apartment.
As the rumors swirl, we at James Hubbard’s My Family Doctor want to give you the straight truth about these medications. The purpose is not to speculate on this tragic story–on what may or may not have caused Ledger’s death–but instead to help those of you who are wondering what the truth is about these medications–meds that you or a loved one may be taking.
We talked with sleep specialist Jim Krainson, M.D., medical director of the South Florida Sleep Diagnostic Center in Miami and spokesperson for the American Academy of Sleep Medicine. Here are the facts as he sees them.
JHMFD: Are sleep medicines dangerous?
JK: If you have a sleep medicine prescribed by a doctor who does not know all your medications, who has not given you the warnings about combining sleep medicines with other medicines; if you have not been given instructions as to how many you can take and not to take extra; if you haven’t been given instructions about warnings about possibility of falls and things like that with sleep medicine; if you haven’t been evaluated–at least history of your current sleep patterns–then I would be very concerned about the sleep medicines.
I mean, all these things should be taken into account before sleep medicines are given. There are some very dangerous conditions which some [not all] sleep medicines can make worse.
One of the conditions is sleep apnea, and that’s where a person actually blocks off their airway at night. And many sleep medicines–again not all–many sleep medicines will actually make your muscles relax so much that it can actually contribute to that and can contribute to respiratory depression, and that can be dangerous.
So the doctor should be asking you if you snore at night, should be concerned if you’re overweight, if you have a large neck size, if you have a thick tongue, if you ever wake up with choking sensations—things like that—before prescribing sleep medicines.
So if your doctor has prescribed your sleep medicine, and if he’s done all the good things, then I would not be overly concerned. He probably prescribed them thinking that you would tolerate them well and gave you good instructions.
Anything short of that, I would go back to your doctor and ask them about, “Am I at risk for taking sleep medicines? Do I have any underlying conditions? Can you determine if I have sleep apnea?”
JHMFD: What if your sleep medicine isn’t working? Should you try taking one more pill?
JK: No, no. Unless you’re–unless it’s been specifically prescribed to take extra ones by your doctor, if you’re not falling asleep in a short period of time–about 15, 20 minutes–you should probably get up out of bed and go do something that’s not stimulating until you feel tired …. And then go back to bed and try and go back to sleep.
Most patients with insomnia–either the difficulty falling asleep or difficulty maintaining your sleep–most can be treated without sleep medicines. And there’s been studies that compare sleep medicines to behavioral therapy–you know, simple sleep-hygiene measures–where behavioral therapy has come out as good if not better in many cases than the medications. And certainly it’s safer.
JHMFD: What are some examples of behavioral changes?
JK: Avoiding caffeine and stimulants in the daytime–caffeine included in coffee, tea, sodas–chocolates have theobromine, which is a relative to caffeine that can be a stimulant; avoiding exercise near bedtime; having a good wake schedule–making sure you get up every morning at the same time, even on weekends if you’re having a problem; avoiding naps in the daytime so that you’re not utilizing your sleep time in the daytime and then trying to fall asleep again at night.
JHMFD: What about alcohol?
JK: Alcohol should be avoided within probably three to four hours of bedtime. Even though alcohol can help induce sleep, it often disrupts sleep later in the night. You get something similar to a mini-withdrawal …. So often people can have disruptive sleep after they just take one drink before bedtime: The second half of the night isn’t so good.
JHMFD: Would you necessarily wake up and realize it?
JK: No, no, just toss and turn or just not be as well rested as you’d expect in the morning.
JHMFD: What about over-the-counter sleep medicines? Are they relatively safe?
JK: They can still cause daytime grogginess in the following day, so they’re not a big threat for causing respiratory failure, but they can cause other problems.
JHMFD: Going back to prescription pills: What if you take just a couple extra? Is that going to kill you?
JK: You shouldn’t take even one extra unless the doctor tells you. And there are some pills that do allow you to take an extra pill if you still have four hours of sleep available at night. But most of them, if you’re taking an extra one later in the night, you’re going to be sleeping into the daytime, and that’s not going to be good. That breaks the sleep hygiene rule of getting up at the same time every day. So you don’t want that. And you certainly don’t want to be awake and under the influence of sleeping pills. Then your functioning during the daytime—your driving—all that can be impaired.
JHMFD: So if you take an extra one, the main risk is that you’d be sleepy and impaired during the day?
JK: Or that you die or something terrible …
JHMFD: Oh, so just one extra could kill you?
JK: Well, it depends on the person. Sometimes one is too many for some people who have certain disorders. So some people shouldn’t take any sleeping pills. So if some people shouldn’t take any sleeping pills, I don’t think we can ever say that an extra one is going to be safe.
JHMFD: Are there any interactions with certain medications that are particularly dangerous that people should be aware of?
JK: Sure. Any other sedative is going to compound or increase their effect. … And certainly alcohol. Now there are some medications—there’s a new one that’s somewhat safer than the others, and that works actually through the melatonin receptors, and it is the only sleep medicine that’s prescription that is not a scheduled medication.
JHMFD: Meaning …
JK: Which means it’s not restricted use. You don’t need a DEA number to prescribe it. It just can be prescribed by anyone. The name of that medicine is ramelteon.
JHMFD: Why do you say it’s somewhat safer?
JK: Sometimes people may have a little sleepiness the next morning, but usually it doesn’t cause respiratory problems, and it usually doesn’t cause any major problems. Since it acts through a natural system—a melatonin system—it doesn’t depress the other parts of the brain as much. It just induces sleep.
This concludes our interview with Dr. Krainson. What do you think about what he has to say? What’s been your experience with sleeping pills? Comments are open below.
Tags: medicine safety, sleep
