Improving Sleep Quality with Prescription Medication (Pros and Cons)
Part 7 of 14-Part Article Series About Sleep Health
Hypnotic drugs (e.g. benzodiazepines and z-drugs) are commonly prescribed to individuals suffering from insomnia [42], despite the fact there are non-pharmacological interventions shown to be more effective in treating insomnia [23,43,44]. The use of prescription sleep aids is more common in America compared to other countries [45]. Hypnotic drugs have been found to significantly increase total sleep time in individuals with insomnia, at least in the short term [23,44,46-48]. However, the effectiveness of hypnotic drugs comes with a price – negative side effects [23,42,46,47,49-53]. In addition, a fair amount of the scientific literature on the effectiveness of prescription sleep aids had involvement/funding from pharmaceutical companies and private sources, indicating a clear bias [42,47]. This suggests positive outcomes were likely over-represented and negative outcomes were under-represented.
Potential Negative Side Effects of Prescription Sleep Medication:
Drowsiness [42,43,46,47,50,52,53]
Tolerance [42]
Dependency [42,47,49]
Withdrawal Symptoms [42,47]
Rebound Insomnia After Drug Discontinuation [23,47,52]
Inhibited Natural Production of Melatonin* [52]
Dizziness [46,47,52,53]
Lightheadedness [52]
Impaired Cognitive Function and Memory [52,53]
Decreased Slow Wave Sleep** and REM Sleep [50]
Headache [43,46,47,53]
Nausea [43,46,47,53]
Nightmares [46]
Gastrointestinal Disturbances [46,53]
Increased Risk of Falls and Motor Vehicle Crashes (in the elderly population)*** [46]
Sleep-Driving and Sleep-Eating [53]
*Reduction in natural production of melatonin may partially explain why prescription sleep medication can lead to rebound insomnia, withdrawal, and dependency (more on melatonin later in this article series).
**A decrease in Slow Wave Sleep (SWS) is a troublesome side effect. As stated in part 3 of this article series, SWS involves particularly restorative physiological processes that play an important role in learning and memory consolidation [5,9,10,12,15,33]. Therefore, prescription sleep medication may improve total sleep time, but the quality of that sleep may be low. Additionally, impaired cognitive performance and memory, which are also side effects of sleep medication, may stem from reduced SWS.
*** The elderly appear to be particularly sensitive to the negative side effects of prescription sleep medication, especially in individuals with cognitive impairment and a high fall risk [46].
With all the possible side effects associated with prescription sleep medication, a relevant question to ask is, “Would I rather feel bad from being sleep deprived, or get a full night of sleep with medication, but then potentially still feel bad in a different way?” Of course, the individual response to the negative side effects of sleep medication is variable. This article shares evidence about sleep medication; it is not intended to persuade or dissuade anyone to use sleep medications (that is an entirely personal decision based on individual circumstances and guidance from healthcare professionals).
Despite the potential negative side effects, prescription sleep aids can be useful for individuals who experience situational insomnia (i.e. insomnia due to time-zone shifts, sleeping in unfamiliar places, or sleeping in places where it is impossible to control environmental variables such as light, sound, and vibrations). With a specific and short-term application of sleep medication for situational insomnia, dependency and withdrawal are not likely to occur, and individuals will not be chronically subjected to negative side effects.
As mentioned in the introduction of this article, non-pharmacological interventions are shown to be more effective in treating insomnia compared to prescription sleep aids [23,43,44]. I will explore the evidence around such non-pharmacological interventions in the next several parts of this article series.
To see the references that relate to the citations in this article, please scroll down to the references section in part 1 of this article series.